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Job ID 2013-22385 # Positions 1
Location US-GA-Atlanta
Search Category Finance
Type Regular Full-Time (30+ hours) Posted Date 5/2/2013
Additional Locations ..

More information about this job:
Summary:

Work directly with Plan and Corporate Office customers and business owners to provide analytical reporting and solutions in support of Medical Cost and Trend Analysis, Medical Expense Initiatives (MEIs), Financial Reporting, Quality Analysis and the development, accomplishment and measurement of strategic initiatives. This requires strong analytical thinking and a thorough understanding of analytical tools, analytic techniques, data nuances, and methodologies.

Responsibilities:

1. Produces, analyzes and maintains reports used to measure, monitor and manage quality of care and service as well as other financial analysis.

2. Utilizes knowledge of databases, information systems, statistical tools and analytical principles to analyze outcomes that support strategies for managing health plan performance.

3. Compiles and analyzes data including quality indicators, performance scorecard and quality improvement activities.

4. Performs statistical tests to determine statistical significance, confidence level, validity and reliability of outcome.

5. Supports systems to provide trended data related to State required clinical outcomes measures.

6. Assists in the development of databases and analysis tools to measure clinical outcomes and prevention initiatives.

7. Develops, standardizes, maintains and enhances reports for State quality reporting.

8. Participates in clinical focus study development, data collecting and analysis.

9. Trends quarterly data and develops aggregate and individual data reports.

10. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors degree in business, science, healthcare or related field.

Years and Type of Experience Required:

Required:
- Minimum 3 years data or finance analysis or statistical experience.

Preferred:
- Previous HMO/Managed Care industry experience preferred.

Specific Technical Skills

Required:
- Proficient with window based environment software tools.
- Stung Microsoft Excel and Access skills.
- Working knowledge of information systems including database design.

Preferred:
- Knowledge of SPSS.
- Understanding of ICD-9 and CPT coding system and claims helpful.

Other:

Required:
- Excellent analytical skills.
- Attention to detail.
- Excellent organizational skills; the ability to handle multiple priorities simultaneously with a high quality result.
- Appreciation of cultural diversity towards target population.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.
- Must be able to operate a calculator.

CB2

ermCorp
]]>http://www.amerigroup-jobs.com/job/Atlanta-Finance-Analyst-Job-GA-30301/2504226/250422625042262013-07-18AmerigroupFinancefull-timeUSDstarting0BSAtlanta, GA, US
Job ID 2013-22014 # Positions 1
Location US-VA-Norfolk
Search Category Pharmacy
Type Regular Full-Time (30+ hours) Posted Date 5/13/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for the development and oversight of program operations across all markets with a focus on program development, program enhancements, managing interdependencies and risks, program status and evaluation, reporting, and program growth/expansion in both new and existing markets. Coordinates with leadership across health plans to ensure consistency with (program name) programs.

Responsibilities:

1. Designs, develops, implements and oversees Health Care program operations across all markets in support of corporate and health plan management; responsible for developing and maintaining indicators for monitoring and evaluating quality care, appropriateness, continuous improvement, member satisfaction, utilization, and overall program direction.

2. Establishes annual strategic goals, objectives and work plans in conjunction with senior leadership.

3. Responsible for ensuring development, training, communication, consistency and coordination across markets; creates program documents, gives presentations on (program name) program for a variety of audiences and mentors health plan associates.

4. Participates in the development of professional relationships with community agencies, advocacy groups and participating health plans.

5. Leads various cross functional workgroups created to maintain, enhance, and/or develop programs.

6. Works collaboratively across health plans and corporate towards identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problems resolution;

7. Serves as liaison with state regulatory agencies, as needed, and assures compliance with state and Federal requirements by collaborating with Corporate Regulatory Compliance and health plans to resolve market issues; has detailed knowledge of (program name) program contract requirements and actively evaluates changes and requests and the potential impact of change to operational areas.

8. Coordinates program deliverables, budget and resources, and is responsible for the resolution of issues that may hinder program success.

9. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in a related discipline with 12 years relevant work experience and at least 7 years of leadership/management experience within a medium to large sized public sector health care organization preferably managed care organizations.

Years and Type of Experience Required:

Required:
- Minimum of twelve years clinical work experience and at least five years of leadership experience in quality management and/or utilization management in a managed care setting.

Certifications or Licensures

Required:
- RN, LCSW, LPC or as defined by the program needs

Preferred:
- RPh/PharmD
- PMP

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent program management skills, with the capability to effectively manage program and processes across multiple areas of the organization.

SCOPE INFORMATION

# Direct Reports: 2-5

# Indirect Reports: 0-10

Budgetary $ Responsibility: Yes, varies with program

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Norfolk-VP-Health-Care-Programs-Pharmacy-Job-VA-23501/2428085/242808524280852013-07-18AmerigroupPharmacyfull-timeUSDstarting0BSNorfolk, VA, US
Job ID 2013-22140 # Positions 1
Location US-VA-Norfolk
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 2/28/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for reviewing medical records for claims submitted to Amerigroup which are potentially related to fraudulent or abusive billing practices. Work closely with all CID associates sharing knowledge, researching issues, documenting findings, drawing conclusions, and addressing issues with providers. Utilize a variety of resources to provide support for findings, keep informed of trends and changes in the medical field, and educate associates and providers. Work with Amerigroup Medical Directors to confirm findings, obtain guidance, and resolve issues relevant to CID investigations or department initiatives.

Responsibilities:

1. Performs all activities to identify, monitor and analyze aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment claims review and post payment auditing. Investigates potential fraud and over-utilization by performing complex medical reviews via prepayment claims review and post payment auditing.

2. Correlates review findings with appropriate actions (provider education, recovery of monies, cost avoidance, recommending sanctions or other actions).

3. Assists investigators by providing medical review expertise to accomplish the detection of fraudulent activities. Trains, educates, develops, and mentors other associates in the department.

4. Interfaces with operational department management, Health Plans and State representatives on fraud and abuse issues. Ensures continuing development of effective professional relationships with the Legal, Medical Management, Claims and Cost Containment Departments.

5. Assists in the development of departmental policies and procedures regarding documentation and coding standards. Develops appropriate process and case documentation to support the mission of the Corporate Investigations Department. 6. Establishes and maintains working relationships with all internal departments and senior management in the plan(s) to which they are assigned including CEO’s, Chief Compliance Officers, medical Directors, Provider Relations, Claims, etc.

7. Analyzes data as part of the investigative process using available resources.

8. Prepares and submits findings and makes recommendations to senior management.

9. Participates in identifying new initiatives and/or projects that will identify and reduce fraud and abuse, to include pre and post payment.

10. Assists in the evaluation and implementation of strategies to flag and evaluation claims of certain providers who are billing out of normal ranges, to include training the providers.

11. Assists in the evaluation, design and implementation of strategies to send communications to providers who are billing out of normal ranges, to include training the providers and monitoring impact on future billing patterns.

12. Develops, maintains and recommends current departmental coding resources.

13. Performs other duties as assigned or requested.

Qualifications:

EDUCATION REQUIREMENTS

Education

Bachelor’s degree in related field such as Nursing, Healthcare Management, or Health Information Systems. Equivalent work experience accepted in lieu of education.

Years and Type of Experience Required:

Required:
- Minimum 5 years claim coding experience with two years medical claims review and/or auditing experience.

Preferred:
- Minimum 5 years claim coding experience with two years medical claims review and/or auditing experience and minimum of two years of health care fraud audit/investigation experience in managed care setting is strongly preferred.
- Previous experience coordinating with internal legal representation.

Certifications or Licensures

Required:
- Certified Professional Coder (Requirement may vary by department).

Preferred:
- Registered Nurse or Licensed Practical Nurse (Requirement may vary by department).
- Certified Fraud Examiner (CFE).
- Accredited HealthCare Fraud Investigator (AHFI).

Language Skills

Required:
- English

Functional Competencies
- Demonstrated experience in Microsoft office products: Word, Excel and Power Point.
- Understanding of CMS 1500 and UB04 billing claim forms.
- Coding experience (ICD-9, CPT-4, E&M and HCPCS).
- Demonstrated experience with data mining, analysis, reporting and business intelligence techniques.
- Experience with healthcare claims systems (Facets and/or AMISYS).
- Experience with desktop coding platforms.
- Ability to provide testimony in civil or criminal hearings.

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 (approximately 10%) and adhere to AMERIGROUP travel policies and procedures.

ermHO
]]>http://www.amerigroup-jobs.com/job/Norfolk-Clinical-Auditor-Reimbursement-Job-VA-23501/2455579/245557924555792013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSNorfolk, VA, US
Job ID 2013-22141 # Positions 1
Location US-VA-Norfolk
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 3/14/2013
Additional Locations ..

More information about this job:
Summary:

Provide leadership and expertise in development and maintenance of rules, policies, procedures and educational processes focused on ensuring organizational compliance with industry standard coding practices. Interpret and apply National Uniform Billing Compliance rules, guidelines, laws and industry trends to support accurate provider reimbursement, system configuration, and ongoing provider education. Proactively address cost efficiencies and compliance requirements. Recommend clinical classification and reimbursement guidelines and standards.

Responsibilities:

1. Reviews claims and medical records routed to the department for billing/coding compliance issues; prepares and submits audit findings to appropriate individuals.

2. Correlates findings with appropriate actions including but not limited to provider education, cost recovery, cost avoidance, policy and coverage guidelines.

3. Coordinates findings and actions with Health Plan Medical Director, Provider Relations and other appropriate staff.

4. Assist in the development of departmental policies and procedures regarding documentation and coding standards. Make coding policy recommendations based upon current trends in code theory and interpretation, industry standard coding, billing practices, state contract language (i.e. CPT, HCPCS, Revenue, ICD.9, DRG, etc), medical compliance and reimbursement policies, such as medical necessity issues and proper coding.

5. Assists in evaluation, design and implementation of strategies to send communications to providers who are billing out of normal ranges.

6. Develops appropriate processes and case documentation to support the mission of the department. Present reimbursement coverage recommendations to Reimbursement and Clinical Policy Committees.

7. Provides technical oversight of coding review resources by the medical coding team. Evaluate coding on provider contract rate sheets. Perform quality assurance functions and rate sheet reviews for code recommendations.

8. Creates and maintains code sets used for configuration in benefits & pricing and other sub-systems. Changes to approved code sets are updated accordingly.

9. Ensures all contracts are properly configured in the appropriate business systems for accurate adjudication and reporting. Assists in the resolution of provider contract configuration or claims payment issues identified in the home office or the plans as needed.

10. Interfaces with operational department management, Health Plans and State representatives on industry standards and National Uniform Billing Compliance issues.

11. Assists in provider, provider office staff and Amerigroup staff education process related to medical code assignments, national coding initiatives, industry standards and required documentation.

12. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in Health Care Management, Accounting or Business, or equivalent experience in lieu of degree(s).

Years and Type of Experience Required:

Required:
- Minimum of 6 years coding (ICD-9, CPT-4, E&M, HCPCS, DRG and Revenue) experience with a minimum of 2 years experience in claims, clinical or managed care environment.
- Previous experience auditing professional fee coding.
- Previous experience providing physician training and education for E&M coding.

Certifications or Licensures

Required:
- AAPC (CPC) or AHIMA (CC) coding. Must maintain licensure, i.e. completion of annual continuing professional education requirements.

Preferred:
- Licensed Practical Nurse (LPN) or Registered Nurse (RN)

Language Skills

Required:
- English

Functional Competencies
- Intermediate to advanced level MS Office skills.
- Advanced understanding of medical terminology, body systems/anatomy, physiology and concepts of disease.
- Ability to analyze, interpret and summarize contracts, regulations, policies and procedures, reports and legal documents.
- Ability to respond to questions/concern from internal/external customers and regulatory agencies and present company position in understandable and unambiguous manner.
- Prior claims processing system knowledge preferred.
- Ability to apply creative/breakthrough methodologies and thinking to the tasks.
- Strong communication skills, both written and verbal; articulate, persuasive & influential; systematic and timely.

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.

ermCS
]]>http://www.amerigroup-jobs.com/job/Norfolk-Sr-Medical-Coding-Analyst-Job-VA-23501/2480267/248026724802672013-07-18AmerigroupCustomer Servicefull-timeUSDstarting0BSNorfolk, VA, US
Job ID 2013-22480 # Positions 1
Location US-VA-Norfolk
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/4/2013
Additional Locations ..

More information about this 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.

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 pri vileges, 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.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High School diploma or equivalent.

Preferred:
- Some college.

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

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.

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.

ermCS
]]>http://www.amerigroup-jobs.com/job/Norfolk-Credentialing-Specialist-II-Job-VA-23501/2530349/253034925303492013-07-18AmerigroupCustomer Servicefull-timeUSDstarting0BSNorfolk, VA, US
Job ID 2013-22546 # Positions 1
Location US-VA-Norfolk
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/16/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for managing members experiencing complex or catastrophic illness, high risk pregnancy, injury and/or specialty illnesses such as diabetes, HIV, transplant, behavioral health conditions, etc., to ensure cost effective and efficient utilization of health services. Conducts continuous skills assessment, planning, implementation, coordination, monitoring and evaluation.

Responsibilities:

1. Obtains an accurate member history, conducts an assessment of biopsychosocial factors, and assesses clinical information to develop care plans including a member support system.

2. Establishes prioritized short and long term goals in collaboration with the member that meet the member’s needs and the referral source’s requirements.

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

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

5. Collaborates with the member’s PCP and specialists in the development of the plan of care to ensure that members’ physical needs are addressed; communicates care objectives to appropriate individuals/departments/referral sources.

6. Provide case management and/or disease management services to members, as identified by a health plan’s referral process.

7. May be required to conduct field visits.

8. May be required to perform service authorization duties using prescribed criteria and responsibilities as assigned and required by the Plan

9. Acts as an advocate for an individual’s health care needs.

10. Reviews benefit systems and cost benefit analysis; evaluates the quality and necessity of applicable services; identifies members that would benefit from an alternative level of care; acquires data and evaluates necessary health services for cost containment; documents effectiveness of case management services

11. Participates in Quality Improvement processes and serves on internal and external committees as required.

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of three years clinically related experience.

Preferred:
- Experience working on the community level and with community agencies.
- Experience in managed care, case management and discharge planning.

Certifications or Licensures

Required:
- Active licensed RN.
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.

Preferred:
- Certified Case Manager.

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

CB1

ermHO
]]>http://www.amerigroup-jobs.com/job/Norfolk-Case-Manager-RN-DMCCU-Monday-Friday-10-AM-to-7-PM-Job-VA-23501/2549314/254931425493142013-07-18AmerigroupNursingfull-timeUSDstarting0BSNorfolk, VA, US
Job ID 2013-22735 # Positions 1
Location US-VA-Richmond
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/10/2013
Additional Locations ..

More information about this job:
Summary:

The VP Finance (Plan) will largely focus and be accountable for identifying and valuing solutions which serve to improve the operating performance of the Plan through strategies and initiatives which contribute to effectively managing operating gain. This includes a focus on topline, capital investments in the local operations, management of local administrative costs, and driving medical expense improvements. This position is responsible for owning, managing, and driving the budgeting, forecasting, and financial analysis functions of the health plan or region to ensure the achievement of membership, premium, medical expense, gross margin, and local SG&A goals on a quarterly and annual basis, plus local analytics and reporting necessary to support business decisions across all functional areas with actionable information. Major activities owned by this position include the annual budget, quarterly forecasts, financial statement analysis and interpretation, ownership of the HCI/CoC process to maximize operating gain, management and tracking of the State P4P incentive programs and process, and participation in the premium rate-setting process. The VP will work collaboratively with health plan and corporate management in all areas of responsibility to ensure the organization is focused on current results vs. budget, current financial performance trends, and the identification and execution of initiatives to properly manage revenue, medical, gross margin, and SG&A to plan. The incumbent will be responsible for partnering with the QM lead to drive the P4P/HEDIS management and the oversight process for analytics and reporting.

Responsibilities:

1. Own topline, medical expense, and local/direct SG&A portions of annual budget process & quarterly forecasts:

a. Drive process with Plan leadership in conjunction with CEO/COO;

b. Conduct/coordinate all analysis required for membership, premium yield, medical expense, quality initiatives, incentive programs, and local/direct admin by product;

c. Provide all required files to Home Office Finance departments within required timeframes.

2. Provide updated topline and medical projections as needed by the Home Office due to material changes in the business environment (new membership, new product, new provider contract, etc.)

3. On a monthly and quarterly basis, provide necessary information to Actuarial for the medical accruals including:

a. Large cases not in claim experience;

b. Major contract changes not in claim experience;

c. Other utilization or unit cost events not in claim experience.

4. Full participation in monthly operational meetings, financial statement meetings, and medical accrual meetings.

5. On a quarterly basis, provide all necessary information for the other known liabilities, including detailed analysis for auditor review, within required timelines of close process.

6. On a monthly basis, analyze, interpret, and communicate financial statement and medical accrual results to plan leadership for the month, quarter-to-date, and year-to-date a. Identify and explain all variances to budget/forecast b. Identify trends & key drivers in revenue and medical and roll them into HCI process for action c. Assess impact on quarterly and full year budget/forecast targets for topline, medical expenses, gross margin, MLR, pre-tax/pre-corporate earnings, and operating gain.

7. Own the HCI program and ensure its success for the health plan in achieving revenue, medical, and gross margin targets on a quarterly and annual basis according to budget/forecast.

8. Conduct and manage all required analysis for the HCI program:

a. Identify, assess, document, and monitor all opportunities to maximize revenue and manage medical expenses to budget/forecast through membership, premium rate, unit cost, utilization, and cost containment initiatives;

b. Ensure 150% of gross margin gap to budget/forecast is explained at all times;

c. Fully utilize process tools and methodologies in accordance with Corporate standards.

9. Fully engage and collaborate with other Plans and Home Office departments to identify, define, and use standard tools and analytical approaches, including use of common data sets. Interaction with Health Care Economics, Finance, Medical Management, Claims, Cost Containment, Provider Service Operations, Program Integrity, and Premium Reconciliation is expected.

10. Participate and contribute to “Best Practice” forums with other Plans and Home Office to share initiative successes, share lessoned learned, identify best practices across the company, and identify new initiatives not currently implemented at the Plan.

11. Monitor monthly cost containment activity, including investigation and resolution of adverse changes in collection activity a. Provide direction to Cost Containment Unit for additional expense savings opportunities not taken.

12. Monitor monthly claims production, including investigation and resolution of adverse changes in production statistics and their impact on medical accrual estimates.

13. Monitor monthly supplemental revenue collections such as Maternity kick payments, Newborn kick payment, and reimbursable drugs, including investigation and resolution of adverse changes in collection activity.

14. Monitor, analyze, and report any variances for local and direct administration expenses.

15. Identify and drive opportunities for savings with Plan leadership on a monthly basis.

16. Work with Actuarial to understand key drivers of the premium development for each product.

17. Identify and monitor the assumptions and issues in the rate methodology that drive financial success including trend, populations covered, benefits covered, unit cost assumptions, risk adjustment, birth rates, newborn enrollment rules, special populations (i.e. AIDS/HIV), utilization assumptions, and program changes.

a. Communicate to key Plan leadership and ensure they understand the drivers of success underneath the premium rates;

b. Monitor performance against quantifiable drivers of premium rates and resolve adverse variances as they arise.

18. Partner with Quality Management Leadership to own and drive any State required P4P incentive programs and HEDIS improvements. Own scorecard development and tracking, sizing of risks and opportunities with achieving premium incentive goals, identify and monitor compliance risks and financial impacts, and provide routine analysis and reporting to QM team to ensure successful initiatives and outcomes:

a. Provide financial and analytical oversight in development of member and provider incentive programs;

b. Provide outcomes reporting and assessment of quality initiatives.

19. Manage all analytics and reporting at the Plan level.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- MBA or CPA

Years and Type of Experience Required:

Required:
- 12 years Managed Care Finance, Accounting, or Actuarial experience in a leadership role in a health plan and at least 5 years leadership management experience Specific Technical Skills

Required:
- Proficient in Microsoft Windows environment including the Office suite of products, proficiency with database programs such as Microsoft Access, advanced skills in Microsoft Excel, advanced analytical skills, and excellent communication skills.

SCOPE INFORMATION

# Direct Reports:

# Indirect Reports:

Budgetary $ Responsibility: Entire Plan budget

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.

Job Title: VP Finance

Job Grade: 23

Salary Range: $101,925 - $135,900 - $169,875

MJO:20%

LTI:15k

ermHO
]]>http://www.amerigroup-jobs.com/job/Richmond-VP-Finance-Plan-Job-VA-23173/2592124/259212425921242013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSRichmond, VA, US
Job ID 2013-22830 # Positions 1
Location US-VA-Richmond
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/13/2013
Additional Locations ..

More information about this job:
Summary:

The incumbent will assist the Health Plan CEO in the fiscal and or operational management of the Health Plan. Responsibilities include serving as the liaison to all Virginia Beach support services and regulators, local network development, provider partnerships, provider relations, medical, case and quality management programs, performance management/improvement, budgets, complaints and appeals, regulatory and contractual compliance, monthly financials, and reporting. Provide input on overall strategic direction especially strategies affected by service delivery matters, operations, practices and policies.

Responsibilities:

1. Establish overall standards, policies and objectives for all Health Plans in accordance with applicable regulatory requirement; ensure alignment and support with overall mission, goals and objectives.

2. Act as a liaison to regulators for operational matters and to home office personnel by working cooperatively to ensure development and nurturing of a collaborative work environment to facilitate involvement in planning and operations as appropriate.

3. Serves as the liaison to all support services, Claims, Enrollment, MPS, Finance, Business Control, Med/Finance, Regulatory Compliance, IT, etc., in Virginia Beach. Participates in cross-company operational activities on an ad hoc (e.g., Service Center Audits) and ongoing (e.g., MOR; QOR) basis.

4. For the first six months, the accountability for the oversight of all health plan medical management programs will be managed by Health Plan CEO including: concurrent review, pre-certification, discharge planning, case management, disease management, provider profiling, quality management, accreditation, health promotion and outreach. Facilitates and collaborates with NCC medical management staff to identify gaps and improve processes. Oversight will be re-evaluated after six months.

5. Accountable for the oversight of the design and development of provider contracts and partnerships to achieve quality, cost management, and strategic business development objectives; develops and negotiates strategic provider contracts on behalf of the Plan.

6. May be accountable for other areas of Plan operations including, but not limited to, marketing, operations, and specific products such as long term care.

7. Leads and manages the Plans performance management/earnings improvement activities. Assists in developing policy and programs to achieve business results through effective financial management.

8. Assists CEO with development and management of the Plan’s annual administrative, medical and capital budget process, monthly reporting and review of financials/accruals.

9. Coach and develop team members; adhere to the Company’s recruitment, selection, termination, and performance management processes. Act as advisor to subordinate managers or staff to help meet established schedules.

10. The CEO will manage the Plan’s complaint, appeals, pended claims, and claims research functions for the first six months and then be re-evaluated.

11. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in relevant field of work or equivalent experience in Business, Healthcare Administration or related field.

Preferred:
- Master’s degree.

Years and Type of Experience Required:

Required:
- At least 14 years of relevant experience including ten years of in-depth experience in the HMO/healthcare field.
- At least 10 years of leadership/management experience.

Language Skills

Required:
- English

Functional Competencies
- Comprehensive knowledge of managed care delivery systems and how they can work to improve quality of care and reduce costs.
- Strong financial management skills.
- Proven project management skills with demonstrated ability in organizing, planning and executing development project from conception through implementation.
- Ability to understand major objectives and break them down into meaningful action steps.
- Ability to understand business strategy and formulate concise solutions to managed care problems.
- Proven ability to affect change and meet business goals, monitor progress and take corrective action when necessary.
- Proven ability and prior experience with negotiating and maintaining public and legislative relationships.

SCOPE INFORMATION

# Direct Reports: As Assigned

# Indirect Reports: As Assigned

Budgetary $ Responsibility: As Assigned

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.

AGP Job Title: COO- Plan

AGP Grade level: 26

AGP Compensation range: $180,000k - $240,000k- $300,00k

AGP MJO: 75-85k

AGP LTI: Based on performance

ermHO
]]>http://www.amerigroup-jobs.com/job/Richmond-COO-Health-Plan-Job-VA-23173/2593840/259384025938402013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSRichmond, VA, US
Job ID 2013-22929 # Positions 1
Location US-VA-Richmond
Search Category Administrative Services
Type Regular Full-Time (30+ hours) Posted Date 6/17/2013
Additional Locations ..

More information about this job:
Summary:

Under general supervision, performs a variety of administration functions and provides administrative support to an executive and/or department. Relies on experience and judgment to plan and accomplish responsibilities.

Responsibilities:

1. Manages executive schedule and time.

2. Assists in meeting planning and preparation work, i.e., drafting agendas, minutes, and information on meetings. Seeks agenda items from other attendees.

3. Prepares draft documents/reports/correspondence for signature or review from dictation, handwritten notes, or on own.

4. Opens, annotates, reviews, and processes incoming mail, determining what mail to forward.

5. Processes appointments, updated, deletions to executive schedule determining priorities of meeting. Promotes time management for executive and their schedule.

6. Plans and schedules all travel based on minimum guidelines.

7. Prepares presentation material and provides guidance on format and layout for other administrators within the department.

8. Prepares supply orders.

9. Acts as an administrative resource to others in department.

10. Prepares requests for capital expenditures.

11. Directs copy and fax activities to others.

12. Assists in design of electronic file systems and maintains electronic and paper files.

13. Prepares new hire, security, temporary and other paperwork needed.

14. Assists with projects.

15. Prepares bi-weekly timesheet and PAL requests for executive(s) and processes these and others for signature.

16. Provides financial report support in review of variance reports.

17. Answers phones, screens calls and redirects calls as needed.

18. Maintains contacts for executive.

19. Prepares expense reports from receipts.

20. May coordinate details of major departmental meetings and/or events.

21. Other duties as assigned or needed.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High School diploma or equivalent with two years additional education.

Years and Type of Experience Required:

Required:
- Minimum of 5 years experience as administrative support to an executive(s) and/or department.
- Knowledge of Microsoft Office to include Outlook, Word, PowerPoint, and Excel with at least two years experience using applications.

Specific Technical Skills

Required:
- Word, Outlook, PowerPoint, and Excel required with testing scores of 90% or better on overall skills with two years of progressive utilization of software in a business environment.
- Ability to exercise judgment and maintain confidentiality.
- Excellent organization skills, ability to set priorities and work under pressure to meet changing deadlines.
- Excellent proofing skills with strong attention to detail. Must provide documents that are error free.
- Excellent verbal and written communication skills and maintain a professional demeanor.
- Practices good telephone etiquette skills, customer service and communications skills.
- Experience in operating a multi-line telephone and other media devices.
- Ability to multi-task while maintaining quality and meeting deadlines.

Preferred:
- Experience using Visio in the work environment to develop flow charts, organizational charts, etc.

Certifications or Licensures

Required:
- 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.

CB1

ermCorp
]]>http://www.amerigroup-jobs.com/job/Richmond-Sr-Administrative-Assistant-Job-VA-23173/2611293/261129326112932013-07-18AmerigroupAdministrative Servicesfull-timeUSDstarting0BSRichmond, VA, US
Job ID 2013-22930 # Positions 1
Location US-VA-Richmond
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/24/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for the management of staff and activities focused on servicing and contracting of physicians and other providers with standard contracts.

Responsible for managing provider issues resolution, education/orientation, evaluation of network adequacy, recruitment and marketing related to physician providers.

Assists COO and Vice President of Provider Relations in assuring that staff is maintaining positive physician relationships, advancing the goals of the Health Plan and promoting consistency with corporate objectives.

Responsibilities:

1. Manages the Provider Services Team.

2. Implements and monitors strategic initiatives outlined in the Health Plan’s business plan.

3. Evaluates the provider network to ensure there is appropriate access for membership.

4. Develops and implements provider recruitments strategies which support the goals of the Health Plan.

5. Collaborates with the Medical Management and Marketing departments to assure their network needs are being met.

6. Manages staff in handling inquiries from providers ensuring appropriate and timely feedback. Takes the lead when issues become escalated and interacts with provider administrators as necessary.

7. Works with Vice President of Provider Relations to develop and maintain departmental policies and procedures

8. Recommends and/or drafts communications relative to Health Plan policies and procedures.

9. Manages staff to achieve goals for office visits and orientations to ensure that providers receive appropriate education regarding Health Plan protocols.

10. Manages staff to achieve positive relationships between the Health Plan and its providers through timely issues resolution

11. Manages staff to achieve earnings improvements and strategic goals.

12. Manages the site visit process as part of the provider credentialing process.

13. Completes all Provider Relations activities necessary to prepare for the annual State audit.

14. Oversees the implementation of contracts including monitoring the completion of the credentialing and data entry functions.

15. Monitors the network to assure the Health Plan is meeting State requirements.

16. Drafts copy for provider bulletins regarding billing guidelines when necessary.

17. Manages the provider services activity related to provider marketing initiatives.

18. Interfaces with all other departments to ensure accurate and appropriate configuration of contracts, database maintenance, provider recoveries, reimbursement rates, benefits configuration, project management, etc.

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

20. Represents the Provider Relations Department at senior management meetings when necessary.

21. Ensures that inventory of provider communication materials is maintained.

22. Monitors provider concerns and issues, and provides feedback to the Vice President of Provider Relations. 23. Assists in developing and communicating the appropriate response to providers.

24. Develops and implements action plans regarding provider satisfaction results.

25. Completes other duties and projects as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- BA/BS degree (or equivalent experience).

Years and Type of Experience Required:

Required:
- 10 years of managed care experience.
- 5 years Medicaid experience.
- 3 years provider relations or network management experience.
- 3 years management experience.

Specific Technical Skills

Required:
- Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
- Knowledge of provider reimbursement methodologies, claims processing, billing practices, and fee schedules.
- Familiarity with provider organizational arrangements; IPA, PHO, Group Practice, etc.
- Strong telephonic and customer service skills.
- Effective presentation skills.

Certifications or Licensures

Required:
- Valid driver’s license.

Other:

Required:
- Leadership skills, ability to take charge when necessary
- Supervisory experience.
- Knowledge of provider compensation and capitation issues.
- Above average negotiation skills.
- Excellent communications and presentations skills.
- Strong analytical abilities.
- Ability to complete multiple projects and to meet deadlines.
- 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 locally.
- Must be able to operate a motor vehicle.
- Must be able to travel on common carrier and adhere to AMERIGROUP’s travel policies.

CB1

ermHO
]]>http://www.amerigroup-jobs.com/job/Richmond-Director-Provider-Relations-Job-VA-23173/2622943/262294326229432013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSRichmond, VA, US
Job ID 2013-22952 # Positions 1
Location US-VA-Richmond
US-VA-Virginia Beach
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/24/2013
Additional Locations US-VA-Virginia Beach

More information about this job:
Summary:

The AVP, Operations will report directly to the COO with a dotted line to the SVP, Operations. The incumbent will work to advance AMERIGROUP’s strategic imperatives as the primary link between the HO and health plan operations. The incumbent will be responsible for health plan dashboards, operations policies, OPEX, best practices and regulatory compliance. The incumbent will build strong working relationships with plan senior management and HO support areas to assist in meeting the goals of the organization. In addition, the incumbent will demonstrate high levels of flexibility by managing projects at the health plan based on strategic priorities. The incumbent will be responsible for identifying and prioritizing health plan opportunities for improvement in the areas of efficiency and effectiveness.

Responsibilities:

1. Partners and supports management across the health plan on assigned projects ensuring company goals and initiatives are met.

2. Participates in Operational process improvement initiatives and facilitates collaborative effort between Health Plan and Corporate operations for implementation.

3. Demonstrate mastery of process improvement methodology (i.e. Six Sigma certification) in appropriate timeframe as directed by management.

4. Works with health plan operations to ensure appropriate key operational indicators are in place for monitoring and analysis.

5. Maintains health plan dashboard of key operational indicators, identifies and reports issues to management.

6. Identifies opportunities for Operational Excellence and works to create seamless processes between HO and the health plan.

7. Works with HO support areas/account managers to resolve operational issues to include enrollment, benefit configuration, call metrics, authorizations, high dollar claims, pended claims, CAMP, appeals, adjustments customer service and policy issues.

8. Assists Health Plan Provider Relations with the resolution of defects resulting from the provider contract request, configuration and implementation processes.

9. Engages in corporate cost containment initiatives by identifying opportunities to maximize dollar recovery.

10. Maintains awareness of HO initiatives to ensure priority alignment and promotes health plan communication and collaboration.

11. Recognizes and utilizes appropriate channels for communication, encourages two-way communication with Plan and Home Office staff to participate in creative program development resulting in improved efficiency and enhanced job performance.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree or equivalent experience in Business, Health Care or related field.

Preferred:
- Master’s Degree

Years and Type of Experience Required:
- Minimum of eight years work related experience.
- Project management or leadership experience in a medium to large size business environment.
- 3-5 years of demonstrated experience in data assimilation & analysis
- Experience with change management.

CERTIFICATION AND LICENSURE

Preferred:
- Black belt quality certification.

Knowledge and Skills
- Excellent analytical, organizational, problem-solving, and communication skills.
- Ability to demonstrate political sensitivity and to work effectively with senior level management as well as with multi-disciplinary teams across department lines.
- Demonstrated leadership in healthcare operations including claim payment and root cause identification.
- Strong leadership, coaching, and staff development skills.
- Strong knowledge of data management and interpretation.
- Conflict resolution/mediation experience.
- Clinical or coding skills a plus.
- Quality training a plus.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a phone.
- Ability to travel a minimum of 25%, as require.

CB1

ermHO
]]>http://www.amerigroup-jobs.com/job/Richmond-AVP-Health-Plan-Operations-Job-VA-23173/2622948/262294826229482013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSRichmond, VA, US
Job ID 2012-19768 # Positions 1
Location US-VA-Norfolk
Search Category Clinical Analyst
Type Regular Full-Time (30+ hours) Posted Date 2/4/2013
Additional Locations ..

More information about this job:
Summary:

To develop, maintain and enhance mechanisms to track, trend, and report quality measures and compliance reports for the health plan(s). To support the continuous quality improvement process needs of the Quality Department and Risk Control and Compliance Operations through comprehensive analysis, documentation and reporting of data pertaining to company performance and compliance goals.

Responsibilities:

1. Collaborates with business data owners to develop, analyze, maintain and submit reports used to measure, monitor and manage quality of care, service, compliance and quality improvement initiatives.

2. Assists in the data analysis, development, reporting and submission of mandatory Health Plan reports to Health and Human Services and other regulators.

3. Manages and validates HEDIS data and projects; assure data integrity and reporting of rates.

4. Develops and utilizes knowledge of databases, information systems, managed care, Medicaid/CHIP population, statistical tools and analytical principles to analyze quality outcomes that support strategies for managing health plan performance.

5. Participates in quality initiatives by assisting with data analysis, project design, inter-rater reliability studies and project documentation.

6. Compiles and analyzes data including comparison of outcome measures to benchmark, identifying trends, completing barrier analysis, and assisting in the identification of activities to reach performance goal. Assures completion, accuracy and timeliness of all reports and data.

7. Performs statistical tests to determine statistical significance, confidence level, validity and reliability of outcome.

8. Supports systems to provide trended data related to member satisfaction, complaint and appeal processes, provider satisfaction, provider access and availability, and other areas required for the quality program evaluation.

9. Conduct troubleshooting with management and IT as problems in data management systems arise to promote consistency in reporting.

10. Participates in clinical focus study development, data collection, analysis and report writing.

11. Coordinates clinical focus study activities, serving as project lead, as assigned.

12. Actively participates in plan-wide or state-wide preparation for accreditation surveys and regulatory audits by creating and maintaining compliance roadmaps, as assigned.

13. Develops, maintains and standardizes reports for State quality and compliance reporting.

14. Functions as expert in QM data retrieval and reporting.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in business, science, healthcare or related field preferred. Equivalent experience considered.
- 3-5 years data analysis or statistical experience or successful completion of Amerigroup Leadership Development Program in lieu of years of experience.
- Proficient with window based environment, particularly Microsoft Excel and Access. Working knowledge of information systems including database design.
- Previous HMO/Managed Care industry experience preferred.
- Knowledge of SPSS, Minitab and SQL preferred.
- Understanding of ICD-9 and CPT coding system helpful.

Knowledge and Skills
- Excellent analytic skills, attention to detail.
- Detailed familiarity with computer systems, word processing, spreadsheet, statistical packages and other data base management software.
- Good organizational skills; the ability to handle multiple priorities simultaneously with a high quality result.
- Excellent writing skills.
- Appreciation of cultural diversity towards target population.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.

CB:MW

HEC:DW


]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Clinical-Quality-Data-Analyst-Medicare-Job-VA-23450/2043273/204327320432732013-07-18AmerigroupClinical Analystfull-timeUSDstarting0BSNorfolk, VA, US
Job ID 2012-20822 # Positions 1
Location US-VA-Norfolk
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 2/12/2013
Additional Locations ..

More information about this job:
Summary:

Performs general research and analysis to support business operations. Determines best practices and suggests how to improve current practices. Develops recommendations to solve problems and issues related to business operations. Prepare presentations to report findings to a functional or project leadership. Gathers business requirements, performs first level analysis, supporting the development and testing processes of assigned functional areas. Analyzes and reports on moderately complex business problems to be solved with automated systems or other resources.

Responsibilities:

1. Perform requirements gathering, analysis, and process and data flow diagramming for simple processes of moderate complexity.

2. Make recommendations for the Resolution of moderately complex design and functional area organizational issues utilizing department resources, business development lifecycle and development methods and software applications.

3. Read and interpret conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, and logical flow charts.

4. 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 development and/or product vendors.

5. Read and interpret a design document.

6. Develop and run moderately complex queries and reports for business analysis and trends.

7. Assist in the development of functional test plans used to verify specific system functions according to actual requirements and established guidelines.

8. Function as a liaison for IT and the business and other cross functional resources and departments.

9. Manage multiple priorities.

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience in a Business Analyst role is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Three years experience in business analysis or functional analysis role.

Preferred:
- Health care industry experience.

Certifications or Licensures

Preferred:
- CCBA certification (Certification of Competency in Business Analysis)

Language Skills

Required:
- English

Depending on the business area for a specific position, competency in one or more of the following may be Required:

Technical Competencies
- Demonstrate a basic understanding of core applications and systems.
- Demonstrate proficiency with all applicable company supported software applications.
- Able to provide professional and appropriate written information to internal and external customers.
- Able to initiate conceptual ideas with practical applications.
- Basic knowledge of the inter-relationship among various managed care operational areas.
- Basic knowledge of current technology trends.
- Able to develop and maintain customer relationships.
- Able to identify, analyze, and solve problems and to work with teams to solve problems.
- Able to develop and implement basic project plans.

Computer Skills and Office Equipment - Intermediate
- Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data. Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.

Spreadsheet Utilization and Management - Intermediate
- Proficient in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools.

Database Utilization and Database Management - Novice

Systems - Intermediate
- Understanding of system's utilization and proficient retrieval of information and processing of the following systems:
- NetworX/Facets – build pricing based on provider contracts using Facets applications. Build benefit plans based on State regulations using Facets benefit applications.
- MACESS – contracts and claim images are stored. MACESS Workflow tool for contract life-cycle.
- Software products from Ingenix for prospective payment system (PPS) – pricing.
- Clearquest is used to track projects –knowledge and familiarity using a project inventory tracking system.

Applications/Tools - Intermediate
- Ability to leverage available tools such as:
- TOAD, UltraEdit, Microsoft Project, Microsoft query analyzer SQL mgr, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity - Basic
- General healthcare, who are our providers (hospitals phy ofc, ancil) who are payors (insurance companies),
- High level claims process, knowledge of general industry how it works.
- More specific knowledge around reimbursement methodology, fee schedules. Per case, per diem, DRG, % of charges, those terms. HIPAA.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping DRG codes, place of service codes (POS),

Government Programs Specific Knowledge:
- Medicare Medicaid programs, CHIP and LTC.
- Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Gather and Document Requirements - Intermediate
- Ability to prepare simple to moderately-complex requirements documents. Ability to facilitate requirements gathering including determining the most efficient and effective way to capture the requirements, and managing kick off and subsequent status meetings. Ability to manage timelines and due dates. Ability to recognize and understand business changes that impact requirements and incorporate changes into documentation. Ability to read and re-read requirements documents multiple times while maintaining detail orientation.

Contracts - Intermediate
- Ability to read a contract and understand the operational requirements the contract creates. Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving-Analytics - Basic
- Critical thinking and problem solving methods.

Project Management - Intermediate
- Skilled in running a project utilizing standard project management tools, techniques and methodology. Keeps projects on task.

Testing - Intermediate
- Functions independently in the creation of simple to moderately-complex test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

Behavioral Competencies:

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-PEGA-Operations-Business-Analyst-II-Job-VA-23450/2195331/219533121953312013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSNorfolk, VA, US
Job ID 2013-22715 # Positions 1
Location US-VA-Norfolk
US-NATIONWIDE
Search Category Pharmacy
Type Regular Full-Time (30+ hours) Posted Date 4/30/2013
Additional Locations US-NATIONWIDE

More information about this job:
Summary:

Responsible for managing the clinical and operational components of the Amerigroup national pharmacy program Medicare lines of business including prior authorizations and coverage determination programs, pharmacy call center, P&T committee, policies and procedures, Specialty Pharmacy, medication therapy management, retrospective Drug Utilization Review (DUR) programs and Medicare required activities. May interface with the health plans within a Region and participate in other clinical programs and operational activities.

Responsibilities:

1. Responsible for leading the development and management of clinical drug policies and pharmacy programs.

2. Effective management of capital and human resources.

3. Responsible for productivity, operational and quality metrics related to various pharmacy programs. Assists in implementation of corporate and health plan pharmacy MEIs to ensure clinical, quality and financial goals are met.

4. Implementation of point of sale intervention, retrospective drug utilization review, polypharmacy, pharmacist case management, retrospective DUR, medication therapy management, disease management, lock-in and other clinical programs.

5. Develops and implements clinical drug policies and related clinical protocols that assure appropriate utilization and cost control.

6. Develops and implements quality assurance activities to ensure regulatory and clinical policy compliance.

7. Manages the review and presentation of drug therapy class reviews, drug monographs, formulary recommendations and clinical policies for the Pharmacy and Therapeutics Committee.

8. Works with project management teams to ensure new lines of pharmacy business meet all contractual and State requirements.

9. Other Duties as Assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- BS degree

Preferred:
- BS in Pharmacy or PharmD

Years and Type of Experience Required:

Required:
- Minimum 7 years of Pharmacy, Healthcare, Medicaid or Medicare work experience with at least 3 years leadership/management experience.

Certifications or Licensures

Required: NA

Preferred:
- Licensed and Registered Pharmacist

Language Skills

Required:
- English

Functional Competencies

Required:
- Performs basic data queries and analysis with applications such as Microsoft Access and Excel.
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent communication and problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

SCOPE INFORMATION

# Direct Reports: 0-8

# Indirect Reports: varies

Budgetary $ Responsibility: As defined

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Norfolk-Director-Pharmacy-Medicare-D-Job-VA-23501/2575519/257551925755192013-07-18AmerigroupPharmacyfull-timeUSDstarting0BSNorfolk, VA, US
Job ID 2013-22948 # Positions 1
Location US-VA-Norfolk
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/24/2013
Additional Locations ..

More information about this job:
Summary:

Under general supervision, research and investigates to modify information systems for functional and operation areas. Responsible for analysis, design, development and testing of custom software, third-party application software, interface development and operational reporting development. Supports license and contract agreements, and functions in as a strong contributor a team environment. Competent to work on most phases of applications system analysis activities but requires instruction and guidance in phases. Meet with decision makers, business owners, and end users to define business requirements for system goals and operational reporting objectives including and identifying risks, wants and needs..

Responsibilities:

1. Resolves basic to moderate business issues, identifies alternatives, determine impact and recommend optimal configuration solutions.

2. Under general supervision, develops moderately complex, data-driven web pages and exercises good judgment in the use of coding standards.

3. Develops moderately complex packages with the use of variables, data types, expressions, control flow statements, arrays and strings to develop.

4. Adheres to existing configuration management procedures and recommends improvements to existing procedures.

5. Reads entity relationship diagrams. Read, interpret, create and maintain moderately complex data flow diagrams and data dictionaries.

6. Develops moderately 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 simple to moderately complex systems in a software application.

7. Evaluates and tests moderately 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.

8. Performs moderately complex SQL queries and updates tables. Performs moderately complex data modeling and database design with minimal of oversight.

9. Performs analysis on new release features and analyzes technical impact on the application and customer’s business process.

10. Performs other duties as assigned.

Qualifications:

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:
- A minimum of 2 years related work experience.

Language Skills

Required:
- English

Technical Competencies:

Computer Hardware, Software and Applications / Office Equipment – Intermediate
- Understands the inter-relationship among various IT applications and systems. Proficient with all applicable company supported software applications.
- Ability to use hardware and software of a computer to complete certain moderately complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Proficiency in a windows environment to include navigation skills and use of internet. Ability to review and draft correspondence in email and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Applications System Analysis - Intermediate
- Solid understanding of object oriented development language, object states and methods, and encapsulation. Solid understanding of variables, data types, expressions, control flow statements, arrays and strings. 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. Understands infrastructure associated with supported applications.

Project Management - Intermediate
- Ability to develop and implement basic project plans.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Norfolk-ITS-Application-Analyst-II-Clinical-Systems-and-Reporting-Job-VA-23501/2622946/262294626229462013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSNorfolk, VA, US
Job ID 2013-23036 # Positions 1
Location US-VA-Norfolk
Search Category Pharmacy
Type Regular Full-Time (30+ hours) Posted Date 6/5/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for training Care Services Technicians, monitoring daily workflow within the department, handling complex prior authorization requests or difficult calls, performing operational functions to support eligibility files including reconciliation, encounter files, benefit design set up and testing, and workflow oversight (includes monitoring of the phone queues via CMS software) in the absence of the Supervisor. Responsible for oversight of turn-around time on authorization requests to ensure that contractual requirements are being met. Additional responsibilities include monitoring of Behavioral Health queues, claims and psych testing for appropriate and timely completion.

Please note: This is a Lead Pharmacy Tech position. You will be required to rotate Sat-Sun 10am-2pm schedule every 3rd weekend. A CPht is required as a qualification for this position.

Responsibilities:

1. Responsible for development/updates of department procedures, to include partnering with appropriate departments in the development of training, process improvement and procedures.

2. Responsible for conducting new hire and other needed training for lower level staff and for providing guidance and direction as needed.

3. Conducts regular quality monitoring/assessment and provides feedback to Supervisor/Manager on training needs and areas of development. Provides daily coaching and technical support to HCMS call center specialists. 3. Assists with after hours on-call rotation, as needed.

4. Responsible for daily oversight of prior authorization turn-around time via reports and use of on line tool. Includes notification of delay to appropriate staff and follow up to ensure completion; reports delays to Supervisor/Manager.

5. Responsible for creating, updating, and maintaining reports as needed.

6. Assist with calls during times of heavy call volume. Provides on line assistance to handle escalated calls from providers and internal sources.

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associates degree, or relevant experience in lieu of degree.

Years and Type of Experience Required:

Required:
- Minimum of six (6) years customer service experience in health care operations with a minimum of three (3) years in a call center environment, and prior Pharmacy Technician or Behavioral Health experience, or

Internal Only:
- Demonstrated proficiency as a Care Services Technician II or Subject Matter Expert in Pharmacy or Behavioral Health.

Certifications or Licensures

Required:
- Certified Pharmacy Technician (CPhT) or experience in lieu of certification is acceptable (i.e. student internship, Pharmacy Tech experience, or demonstrated proficiency as a Care Services Technician II.

Language Skills

Required:
- English

Functional Competencies

Required:
- Advanced MS Office skills.
- Experience with healthcare information management systems (Facets, MACESS, etc.).
- Computer keyboarding skills.
- Strong organization and reporting skills.
- Ability to work well with other team members.
- Good communication skills, both written and verbal.

Preferred:
- Knowledge of productivity, adherence, call coaching/quality and other key measures.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Norfolk-Care-Services-Technician-III-Job-VA-23501/2643150/264315026431502013-07-18AmerigroupPharmacyfull-timeUSDstarting0BSNorfolk, VA, US
Job ID 2013-22582 # Positions 1
Location US-NY-Brooklyn
US-NY-New York
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 4/15/2013
Additional Locations US-NY-New York

More information about this job:
Summary:

Manages and coordinates the Enrollment Department functions to ensure the accurate and timely update of the Enrollment database, redirecting the focus of the department activities, as necessary, to meet deadlines. Oversees workflow and productivity, utilizing in-depth knowledge of all Enrollment policies and processes to guide and educate the Enrollment staff. Responsible for the timely notification to the Health Plans, other Corporate Departments and State representatives, as necessary, of Enrollment issues that may impact the timely load of enrollment data.

Responsibilities:

1. Manages staff to meet or exceed department goals, including productivity metrics, quality and timeliness standards as defined by department guidelines.

2. Reviews and analyzes contract changes for impact on enrollment processes; implements procedures in concert with contract requirements and federal and state laws.

3. Oversees the development of necessary user documentation and process flows to assist in the support and training of staff. Ensures documentation of all procedures.

4. Maintains in-depth, current knowledge of contractual and legal/regulatory requirements for multiple markets.

5. Assists in the development of policy and procedures for the Enrollment Department, and ensures adequate internal controls, including SOX and HIPAA controls, exist for all processes. Participates in market audits as needed.

6. Serves as Subject Matter Expert and liaison for technical projects.

7. Coordinates and interfaces with implementation team on new market/product implementations. Review and analyze contract changes for impact on the enrollment processes.

8. Oversee the development of necessary technical and user documentation to assist in the support and training of the staff. Ensure the documentation of all procedures.

9. Reviews and determines areas of improvement within the department and makes adjustments to achieve best performance possible, working with other impacted departments at the corporate and plan level as appropriate.

10. Responsible for recruiting, hiring, managing performance, ensuring compliance with all regulatory requirements, training and coach staff.

11. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in Health Care Management, Finance or Business or equivalent experience.

Years and Type of Experience Required:

Required:
- Five or more years experience in Enrollment in the healthcare industry, with at least one year of leadership/supervisory experience or successful completion of Amerigroup’s LDP program.

Preferred:
- Medicaid enrollment and membership reconciliation experience.

Language Skills

Technical Competencies Computer Skills and Office Equipment
- Advanced: Ability to use software and hardware of a computer to complete certain moderate to complex tasks.
- Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard.
- Use of internet.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use spreadsheets to review, organize and edit data. Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.
- Ability to use of complex applications of software to analyze and solve business problems.

Spreadsheet Utilization and Management - Advanced
- Expert level of proficiency in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools. Ability to create spreadsheets in spreadsheets.

Industry Knowledge & Familiarity - Basic
- General understanding of the healthcare industry including who are providers (hospitals phy ofc, ancil), who are payors (insurance companies) and how the industry works
- General understanding of the claims process.
- More specific knowledge around reimbursement methodology, fee schedules and related terminology, e.g. per case, per diem, DRG, % of charges, etc. HIPAA.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping (DRG) codes, place of service codes (POS), etc.

Government Programs Specific Knowledge
- Medicare Medicaid programs, CHIP and LTC.
- Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Sees the "big picture" (e.g., overall themes, trends, goals).
- Integrates and balances big-picture concerns with day-to-day activities.
- Establishes strategies for achieving individual or work unit goals.

Make Sound Decisions
- Analyzes, incorporates and applies new information and concepts.
- Recognizes symptoms that indicate problems.
- Makes sound decisions on everyday issues and problems.
- Makes timely decisions on problems/issues requiring immediate attention.

People Leadership Develop/Support Organizational Talent
- Identifies and recruits/refers qualified people.
- Makes accurate evaluations of people's capabilities and fit.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Ensure Collaboration
- Provides sound rationale for recommendations.
- Solicits support for ideas.
- Ensures that own positions address others' needs and priorities.
- Builds relationships to create a foundation for future influence.

Results Leadership Show Drive and Initiative
- Identifies what needs to be done and does it.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Conveys clear expectations for assignments.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Seeks additional resources to complete tasks when needed.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Brooklyn-Mgr-Enrollment-Job-NY-11201/2546970/254697025469702013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSBrooklyn, NY, US
Job ID 2013-22606 # Positions 1
Location US-NY-Brooklyn
US-NY-New York
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 4/17/2013
Additional Locations US-NY-New York

More information about this job:
Summary:

Responsible for the overall administration and management of the Enrollment Operations Department, including planning, providing strategic leadership, coordinating information and establishing departmental operating practices. Responsible for the overall direction and guidance of the Enrollment Operations Department ensuring the quality of the Enrollment database and efficient operation of the department for the service of the membership.

Responsibilities:

1. Oversees department to meet or exceed departmental goals and staying within budget, including productivity metrics, quality and timeliness standards as defined by department guidelines.

2. Develops performance-based metrics to facilitate measurement of staff productivity, to continually increase performance.

3. Develops and document process flows and policies for the department to support company goals and objectives. Ensures processes are in line with state and federal contracts and the strategic vision of the organization.

4. Determines root causes of contractual deficiencies, and develops documentation to facilitation remediation.

5. Performs quality assurance functions to ensure Sarbanes-Oxley (SOX) controls are in place and valid. Initiates action plans to resolve issues, and implements procedures in concert with contract requirements and federal and state laws.

6. Serves as primary department liaison for Enrollment activities in state, federal and organizational audits.

7. Reviews and responds to contract proposals and oversees the implementation of new business for the Enrollment department.

8. Performs project management functions in achieving the timely completion of Enrollment deliverables.

9. Works collaboratively with inter-departmental work groups on key organizational initiatives and implementations.

10. Manages the recruitment, interview, and hiring process for potential candidates. Responsible for performance management of associates on a recurring basis to include reviews, corrective action, and recognition programs. Ensures training and development to staff; mentors Managers; provides performance coaching and feedback.

11. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in Information Systems, Health Care Management, Business or equivalent experience

Years and Type of Experience Required:

Required:
- Seven years of enrollment experience in a healthcare insurance company, with at least three years of leadership/management experience.

Preferred:
- Project Management experience.

Language Skills

Required:
- English

Technical Competencies Computer Skills and Office Equipment - Advanced
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data. Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems. Spreadsheet Utilization and Management
- Advanced: Expert level of proficiency in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools. Ability to create spreadsheets in spreadsheets.

Industry Knowledge & Familiarity - Basic
- General understanding of the healthcare industry including who are providers (hospitals phy ofc, ancil), who are payors (insurance companies) and how the industry works.
- General understanding of the claims process.
- More specific knowledge around reimbursement methodology, fee schedules and related terminology, e.g. per case, per diem, DRG, % of charges, etc. HIPAA.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping (DRG) codes, place of service codes (POS), etc.

Government Programs Specific Knowledge
- Medicare Medicaid programs, CHIP and LTC.
- Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Integrates and balances big-picture concerns with day-to-day activities.
- Conveys a thorough understanding of own area's strengths, weaknesses, opportunities, and threats.
- Evaluates and pursues initiatives, investments, and opportunities based on their fit with broader strategies.
- Stays abreast of key competitor actions and their implications or threats to the business.

Make Sound Decisions
- Focuses on important information without getting bogged down in unnecessary detail.
- Probes and looks past symptoms to determine the underlying causes of problems and issues.
- Brings to bear the appropriate knowledge, information, and expertise in making decisions.

People Leadership Develop / Support Organizational Talent
- Identifies the qualifications required for successful job performance.
- Provides honest, helpful feedback to others on their performance.
- Helps others identify and prioritize their development objectives.
- Promotes sharing of expertise and a free flow of learning across the organization.

Ensure Collaboration
- Discourages "we vs. they" thinking.
- Appropriately involves others in decisions and plans that affect them.
- Works to remove barriers to collaboration.
- Seeks to understand and address the concerns and interests of others with opposing viewpoints.

Results Leadership Show Drive and Initiative
- Does not easily give up in the face of unexpected obstacles.
- Sets high standards of performance for self and others.
- Puts in extra effort and work to accomplish critical or difficult tasks.
- Tackles tough challenges or problems quickly and directly.

Accountability/Optimize Execution
- Conveys clear expectations for assignments.
- Delegates assignments to the lowest appropriate level.
- Monitors progress of others and redirects efforts when goals change or are not met.
- Holds people accountable for achieving their goals.

SCOPE INFORMATION

# Direct Reports: 3-5

# Indirect Reports: 40 - 60

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Brooklyn-Director-Enrollment-Job-NY-11201/2551824/255182425518242013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSBrooklyn, NY, US
Job ID 2013-22372 # Positions 2
Location US-NY-Brooklyn
Search Category Sales & Marketing
Type Regular Full-Time (30+ hours) Posted Date 5/16/2013
Additional Locations ..

More information about this 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.

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.

Qualifications:

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 and/or Life 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.

ermSM
]]>http://www.amerigroup-jobs.com/job/Brooklyn-Account-Rep-Medicare-Advantage-%28Cantonese%2C-Mandarin-speaking-required%29-Job-NY-11201/2602073/260207326020732013-07-18AmerigroupSales & Marketingfull-timeUSDstarting0BSBrooklyn, NY, US
Job ID 2013-23083 # Positions 1
Location US-NY-Brooklyn
US-NY-New York
Search Category Sales & Marketing
Type Regular Full-Time (30+ hours) Posted Date 6/11/2013
Additional Locations US-NY-New York

More information about this job:
Summary:

The AVP Retention reports to the NY Marketing Leader and is responsible for setting the strategic direction and leading the retention department in the NY Health Plan. This person is responsible for the overall retention rate of the NY health plan. Duties include development of strategy to optimize resources, management of both internal and external retention units and integration of technology to maximize functionality

Responsibilities:

1. Participates in the development of annual membership and revenue budgets as it relates to retention and continuously seeks to reduce acquisition and retention costs per member per month.

2. Provides technical assistance to ensure the health plan creates and executes a strategic retention plan covering each product.

3. Develop organizational structure and processes to maximize member retention for the NY health plan.

4. Ensure compliance with state and municipal laws, rules, and guidelines for retention and outreach.

5. Oversee both internal and field operations to implement retention program.

6. Works closely with Sales and Enrollment to develop strategies to maximize CHIP enrollment and quality improvement from sales activity.

7. Establish performance metrics and direct management to ensure health plan meets desired objectives.

8. Identify and manage data input and reporting tools that communicate with sales and enrollment.

9. Identify and develop technology components that allow for progressive improvement and coordination of retention resources.

10. Develop messaging congruent with brand identity and coordinate outreach efforts with Corporate Retention.

11. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor of Arts or Bachelor of Science Degree.

Preferred:
- Masters of Business Administration

Years and Type of Experience Required:

Required:
- Seven years of experience in a Medicaid Managed Care environment with three or more years management in either a sales or retention capacity and experience leading an organization of at least 50 people.

Preferred:
- Seven years of experience in a Medicaid Managed Care environment with three or more years management in either a sales or retention capacity and experience leading an organization of at least 100 people.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Intermediate
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment, in particular with Word and Excel, to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Read, Interpret and Apply information - Intermediate
- Ability to read, comprehend and interpret complex information to provide accurate and appropriate information to business partner or customer.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
- Ability to understand when to escalate erroneous/inconsistent information discovered in resources to appropriate level of management for review.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability/Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

Other:
- Able to present information verbally, and in writing, in a concise and effective manner.
- Demonstrate ownership skills when handling internal or external customer concerns or issues.
- Able to identify problems and develop satisfying solutions.
- Demonstrates motivation and innovation for self-improvement.
- Demonstrates basic understanding of healthcare industry.
- Demonstrates knowledge of how position is related to unit/team within a department.
- Able to participate in teams as a strong team participant.

SCOPE INFORMATION

# Direct Reports: 5

# Indirect Reports: 75

Budgetary $ Responsibility: $4,500,000

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.

ermSM
]]>http://www.amerigroup-jobs.com/job/Brooklyn-AVP-Retention-NY-Job-NY-11201/2656533/265653326565332013-07-18AmerigroupSales & Marketingfull-timeUSDstarting0BSBrooklyn, NY, US
Job ID 2013-22811 # Positions 16
Location US-VA-Virginia Beach
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 6/11/2013
Additional Locations ..

More information about this job:
Summary:

Under general supervision, licensed clinician responsible for day to day telephonic medical management and pre-authorization activities. Manages member care ensuring essential, effective, appropriate and coordinated behavioral and physical health and social services. Acts as a member advocate, seeking and coordinating solutions to member health care needs.

This position will be located in our National Call Center in Virginia Beach, VA. All associates will need to have a current LPN or RN license in the State of Virginia.

Responsibilities:

1. Provides telephonic advice and education on the pre-authorization process to members.

2. Maintains and utilizes working relationships with and knowledge of referral sources and community resources.

3. Adheres to all company and state policies, accreditation standards and regulatory guidelines.

4. Utilizes the application of medical management criteria or other company designated criteria.

5. Acts as a clinical resource to other internal departments.

6. Communicates to assigned supervisor or leads all cases needing a higher level of intervention.

7. Documents all pre-certifications and authorization requests as well as all member encounters utilizing the appropriate systems and resources.

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

9. Collaboratively works with other departments.

10. Participates in Quality Improvement processes.

11. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma, or
- Associate’s Degree in related Health/Nursing Field

Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing Field

Years and Type of Experience Required:

Required:
- 2 Years experience as a licensed RN
- or 3 years experience as a licensed LPN/LVN in the Health Care or Managed Care Industry

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

Certifications or Licensures

Required:
- Active licensed LVN or LPN

Preferred:
- Active licensed RN

Language Skills

Required:
- English

Preferred:

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment-Intermediate
- Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.

Communication Skills

Verbal, Written and Call Handling
- Ability to use proper language, grammar and style in the preparation of verbal and written messages to convey a clear, concise, friendly and appropriate message to business partners and customers.
- Skills to properly handle a telephone inquiry into the contact center. Properly greet the customer and provide information based on purpose for the call and script requirements.
- Ability to prepare, edit and convey a variety of messages including presentations, training materials and updates. Ability to handle escalated issues to diffuse concerns through verbal and written messages. Heath Care Industry terminology.
- Ability to understand basic health care industry terms. Ability to understand how an insurance claim works and use the explanation of benefits to explain details to providers.

Read, Interpret and Apply information
- Ability to read and comprehend information and provide detailed explanation to the business partner or customer that is accurate and appropriate.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.

Medical Terminology and Anatomy
- Understand medical terminology to review clinical certifications. Hands on clinical skills to understand the workings of the human body to review and apply clinical criteria to certifications.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Nurse-Coordinator-NCC-Job-VA-23450/2656536/265653626565362013-07-18AmerigroupNursingfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22592 # Positions 1
Location US-GA-Atlanta
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/15/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective care management, utilization of health, mental health, and substance abuse services.

Responsibilities:

1. Manages and oversees teams responsible for various HCMS functions including utilization management, case finding and coordinating those cases that involve co-morbid conditions and need to be part of the case management/disease management track.

2. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.

3. Works with providers to establish short and long term goals that meet the member’s need, functional abilities and referral sources requirements.

4. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.

5. Coordinates the identifications of members with potential for high risk complications; assesses members’ present level of physical/mental impairment utilizing defined criteria and methodology.

6. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.

7. Review benefit systems and cost benefit analysis.

8. Evaluates the member against level of care criteria.

9. Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma or Associate’s Degree in related Health/Nursing/Social Work field.

Preferred:
- Bachelor’s Degree in related Health/Nursing/Social Work field or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of five years experience in health Care Management and at least one year of leadership/management experience.

Certifications or Licensures

Required:
- RN, PA, LSW, MSW, LPC, LCSW LMHC, or LPN/LVN
- Behavioral Health may also have LMSP in addition to any of the above.

Preferred:
- Certified Case Manager or Certified Utilization Review Professional.

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
- Strong communication skills, both written and verbal; articulate, persuasive & Influential; systematic and timely.
- Demonstrate project management experience in organizing, planning and executing large-scale projects from conception through implementation.
- Experience in leading and developing people.

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: N/A

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.

CB1

ermHO
]]>http://www.amerigroup-jobs.com/job/Atlanta-Manager-Health-Care-Management-Services-Job-GA-30301/2546965/254696525469652013-07-18AmerigroupNursingfull-timeUSDstarting0BSAtlanta, GA, US
Job ID 2013-22923 # Positions 1
Location US-GA-Atlanta
Search Category Human Resources
Type Regular Full-Time (30+ hours) Posted Date 5/21/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for the development and delivery of initial and ongoing technical and professional skills training programs, with emphasis in the VA Medical Management department and in the Plans.

Responsibilities:

1. Principal liaison to Virginia Beach and Health Plan medical management departments.

2. Work closely with business partners.

3. Develop, implement and deliver training programs utilizing adult learning theories and principles.

4. Monitor key business indicators in order to identify training needs.

5. Utilize appropriate methods, techniques, and equipment.

6. Monitor effectiveness of programs and progress of trainees.

7. Support business operations.

8. Partner with plan associates to ensure training and development needs support key business objectives.

9. Provide feedback to business partners regarding challenge areas to improve productively and procedures.

10. Utilize superb platform skills to present technical information effectively in a classroom setting, one on one or using distance learning technology.

11. Other special projects and duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- College degree or equivalent experience.

Preferred:
- Bachelor’s or Master’s degree; training certification.

Years and Type of Experience Required:

Required:
- Managed Care Experience.
- 3-5 years training experience; technical training considered a plus. Training experience includes 1:1 training, SME experience, mentor, preceptor, classroom, etc. Does not need to be in an official training capacity.

Preferred:
- Case Management and/or Utilization Management experience or certification desirable.
- Training experience, preferably in health care.
- Technical background considered a plus.

Specific Technical Skills

Required:
- Working knowledge of Microsoft Office applications.

Certifications or Licensure

Required:
- LPN

Preferred:
- RN
- Training or managed care certification highly desirable.

Other:

Required:
- Capable of managing multiple, simultaneous projects.
- Demonstrated ability to succeed in a fast-paced, constantly changing environment.
- Appreciation of cultural diversity and sensitivity towards target population.
- Ability to become a subject matter expert in a variety of topics.
- Demonstrated ability to interface with employees and customers with a high degree of tact and diplomacy.
- Ability to meet company travel requirements.

Preferred:
- Healthcare information systems experience highly desirable.

Travel – Technical Trainers Up to 30%

Travel – Case Management / CarePlus Trainer May require up to 100%

PHYSICAL REQUIREMENTS
- Must be able to operate computer, phone and general office equipment.
- Must be able to travel as required using common carriers and adhere to AGP’s travel policies.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Atlanta-Clinical-Trainer-Job-GA-30301/2609153/260915326091532013-07-18AmerigroupHuman Resourcesfull-timeUSDstarting0BSAtlanta, GA, US
Job ID 2013-22727 # Positions 10
Location US-GA-Atlanta
Search Category Sales & Marketing
Type Regular Full-Time (30+ hours) Posted Date 5/2/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for growing membership through educating and servicing the Medicaid population; including meeting the communities need for ongoing educational and social service outreach to existing and potential members.

Our Marketing Department has a need for Marketing Consultants/ Contractors in the following areas;
- North GA - Dalton/ Whitefield Co (Bi-lingual REQUIRED)
- East / Richmond Co.
- Southeast – Brunswick / Glynn & Camden Co
- Central Region – Macon / Bibb Co

Responsibilities:

1. Acts as service representative for assigned projects and acts as a resource to the membership and the community as needed.

2. Ensure consistent compliance with all state, federal and Amerigroup specific requirements.

3. Assist with establishing and maintaining positive relationships with community organizations, provider offices, faith based organizations and perform other activities to enhance Amerigroup’s presence in the community.

4. Conducts presentations, staff exhibits and perform other activities in an effort to maintain and establish positive relationships with providers, community and faith based organizations.

5. Identify and collect educational material on community networks and advocacy groups with similar missions and values and communicate the information to management.

6. Provides telephonic assistance, outreach and/or guidance to members and potential members regarding benefit and enrollment questions, and/or providing assistance on any social service needs.

7. Assists potential and existing members with the enrollment or recertification process, where appropriate and compliant with local market regulations.

8. Supports health education activities and referral of members to health education programs.

9. Represents Amerigroup at community organizations and events such as promotions, enrollment events (where appropriate and compliant with local market regulations.) and health fairs.

10. Identifies cultural issues regarding current and potential members and communicates those issues and concerns to management.

11. Assists with retention activities necessary to ensure resolution to members around continuity of care issues.

12. Assists with activities necessary to ensure resolution to potential members around continuity of care issues.

13. May be required to drive COV per plan requirements.

14. Other duties as assigned.

ADDITIONAL REQUIREMENTS:

Our Marketing Department has a need for Marketing Consultants/ Contractors in the following areas;

North GA - Dalton/ Whitefield Co (Bi-lingual REQUIRED)

East / Richmond Co.

Southeast – Brunswick / Glynn & Camden Co

Central Region – Macon / Bibb Co

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High School

Preferred:
- Associates Degree or BS/BA degree.

Years and Type of Experience Required:

Required:
- 1 yr experience in healthcare or sales/marketing environment.

Certifications or Licensures

Required:
- Must possess a valid driver’s license and have access to a motor vehicle and must possess valid motor vehicle insurance.

Preferred:
- Valid state health insurance licensure.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Basic
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment, in particular with Word and Excel, to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Experience working with SalesForce.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.

Read, Interpret and Apply information - Basic
- Ability to read, comprehend and interpret complex information to provide accurate and appropriate information to business partner or customer.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
- Ability to understand when to escalate erroneous/inconsistent information discovered in resources to appropriate level of management for review.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies. - Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

Other:
- Able to present information verbally, and in writing, in a concise and effective manner.
- Demonstrate ownership skills when handling internal or external customer concerns or issues.
- Able to identify problems and develop satisfying solutions.
- Demonstrates motivation and innovation for self-improvement.
- Demonstrates basic understanding of healthcare industry.
- Demonstrates knowledge of how position is related to unit/team within a department.
- Able to participate in teams as a strong team participant.

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 lift 25 pounds or more.
- Must be able to sit for long periods of time.

ermSM
]]>http://www.amerigroup-jobs.com/job/Atlanta-Marketing-Rep-Consultants-%28Dalton-Co_-Bi-lingual-REQUIRED%2C-Whitefield-Co_-Bi-lin-Job-GA-30301/2578751/257875125787512013-07-18AmerigroupSales & Marketingfull-timeUSDstarting0BSAtlanta, GA, US
Job ID 2013-23084 # Positions 1
Location US-TN-Nashville
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 6/11/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for conducting telephonic or face-to-face assessments for the identification, evaluation, coordination and management of Members’ needs, including physical health, behavioral health, social services and long term services and supports; develops the Member’s Individualized Service Plan to address those needs. Establishes relationships with referral sources and community resources, while maintaining strict member confidentiality and complying with all HIPAA requirements.

Responsibilities:

1. Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team

2. Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members’ health care needs while optimizing efficiency and quality outcomes.

3. Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member’s PCP or treating physician and specialists in the development of an Individual Service Plan.

4. Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.

5. Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member’s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.

6. Reviews benefit options, acquire data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.

7. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required: (as appropriate, based upon state contract licensure requirements).
- Nursing Diploma or Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role.

Preferred:
- Experience in home health, health care, discharge planning, behavioral health, collaborating with nursing facilities, community resources, and/or other home and community-based agencies.
- Experience working with Medicare, Medicaid, and managed care programs.

Certifications or Licensures

Required:
- Active licensed RN, LPN/LVN, LSW or LCSW, LMSW, as required by state contract.
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.

Language Skills

Required:
- English

Preferred:
- Bilingual (ability to read, write, and speak)

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with case or utilization management data systems.
- Solid understanding of the healthcare industry and government insurance programs.
- Seeks opportunities to acquire new knowledge and skills.
- Accepts feedback openly, without becoming defensive.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Follows up with customers to ensure problems are solved.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Nashville-Care-Coordinator-SumnerWilliamson-Job-TN-37201/2656534/265653426565342013-07-18AmerigroupCase Managementfull-timeUSDstarting0BSNashville, TN, US
Job ID 2013-22984 # Positions 1
Location US-VA-Richmond
Search Category Health Care Administration
Type Regular Full-Time (30+ hours) Posted Date 5/31/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for the development, implementation and oversight of integrated Medical Management primarily in the Health Plan. These initiatives will include the establishment of indicators for monitoring and evaluating quality care, appropriateness, continuous improvement, member satisfaction, utilization, and case management across the continuum of care to members. Provides education in the area of healthcare management. Serves as liaison to state regulatory agencies. Participates in accreditation of plan with the National Committee of Quality assurance. Develops professional relationships with community agencies.

Responsibilities:

1. Directs and provides leadership for designing, developing, and implementing the local Plan integrated medical management program to meet the demographic and epidemiological needs of the population serviced.

2. Directs Healthcare Management Program for membership including disease management, case management, and utilization management.

3. Establishes objectives and annual goals in conjunction with the Medical Director to meet objectives established by the Plan CEO/COO and corporate HCMS.

4. Promotes understanding, communication, and coordination of Integrated Medical Management Programs across the health plan.

5. Works with Provider Relations, Quality Management and Health Promotions to develop and implement effective provider communications, quality assurance and member outreach programs.

6. Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.

7. Coordinates on a quarterly basis reporting of quality initiatives to all appropriate plan committees.

8. Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.

9. Monitors and makes recommendations for oversight of appropriate delegated services.

10. Develops the annual operating and capital budget: ensures that departments stay within budget and accounts for variances.

11. Works collaboratively with key health care professionals toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problems resolution.

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors Degree in a health care field or equivalent experience (equivalent experience equates to 6 years related experience in addition to the required 12 years experience).

Preferred:
- Masters Degree in a health care field, or
- MBA with Health Care concentration.

Years and Type of Experience Required:

Required:
- Minimum of 12 years relevant clinical work experience and at least 7 years of leadership/management experience preferably in a managed care setting , with at least 5 years of clinical experience (post Masters for Behavioral Health).
- Previous experience with NCQA accreditation and HEDIS reporting.

Certifications or Licensures

Required:
- RN, LCSW, LPC

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

SCOPE INFORMATION

# Direct Reports: 5-30

# Indirect Reports: varies

Budgetary $ Responsibility: As assigned

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.

Job Title: VP HCMS

Job Grade: 23

Salary Range: $101,925 - $135,900 - $169,875

MJO:20%

LTI:15k

ermHO
]]>http://www.amerigroup-jobs.com/job/Richmond-VP-Healthcare-Mgmt-Svcs-Job-VA-23173/2633191/263319126331912013-07-18AmerigroupHealth Care Administrationfull-timeUSDstarting0BSRichmond, VA, US
Job ID 2013-23013 # Positions 1
Location US-VA-Richmond
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 6/3/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for functional area business analysis and how the functional areas interrelate, gathering requirements, performing analysis, managing the design, configuration, development and testing processes and system changes, and understanding the applications, data, and associated technologies for supported areas. Analyzes data for studies of management and operational procedures to determine cost efficiency, corrective action and compliance with goals and objectives. Analyze highly complex business problems to be solved with automated systems and other resources. Develops and maintains positive client relationships in functioning as the liaison between the business, health plans, operational areas and Information Technology Services (ITS). Work with staff to ensure requirements will be incorporated into system design and testing. Support departmental methodologies and provide input for improvement to tools and processes. Leads cross-functional linked teams to address business or systems issues. Acts as an advocate to ensure quality and timeliness of project deliverables. Provide leadership within the team, department, and organization.

Responsibilities:

1. Perform detailed requirements gathering, analysis, design, configuration, and process and data flow diagramming for processes of high complexity. Understand and consider the relationship between processes and business policies.

2. Function as a liaison between business, health plans, operational areas, and ITS.

3. Identify risks and multiple solutions.

4. Recommend and implements improvements to existing procedures. Influence others to follow existing procedures.

5. Lead all system/application testing for implementations, conversions, upgrades and updates including individual claim and batch testing. Ensure all application updates are implemented timely.

6. Develop and adhere to existing configuration management procedures. Recommend improvements to existing procedures.

7. Read and interpret design document conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

8. Develop complex queries and reports. Perform database updates.

9. Write, revise, and verify test plans for multiple complex systems in a software application. Provide leadership and guidance to other analysts in the creation of system test plans.

10. 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.

11. Validate proposed contracts meet requirements taking into consideration financial arrangements and impacts as they apply to the budget as applicable in functional area of responsibility.

12. Make technical and functional business recommendations based on evolving technologies and evolving application trends to include infrastructure, software, database, and networks.

13. Address business challenges to improve efficiency and decision making, reduce redundancy, and ultimately enhance business results.

14. Manage multiple priorities and projects.

15. Lead and mentor functional area team members and other Business Analysts.

16. Manage project related budgets as applicable in functional area of responsibility.

17. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience in a Business or Systems Analyst role is acceptable in lieu of a degree(s).

Preferred:
- Master’s degree.

Years and Type of Experience Required:

Required:
- 8 years experience in systems analysis, or business analysis.

Preferred:
- Health Care industry experience.

Certifications or Licensures

Preferred:
- CBAP (Certified Business Analyst Professional)

Language Skills

Required:
- English

Depending on the business area for a specific position, competency in one or more of the following may be Required:

Technical Competencies

Required:
- Comprehensive knowledge of core IT applications and systems.
- Advanced knowledge and skills as a subject matter expert in one or more of the following managed care business areas: Member Enrollment, Provider Information Management, Claims Processing and Adjudication, Benefits Configuration, and/or Call Center.
- 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.
- Able to develop creative strategies and tap the creative potential of individuals and groups.
- Able to continually assess needs and implement measures to ensure customer expectations are met or exceeded.
- Able to turn problems into opportunities for change.
- Advanced proficiency with all applicable company supported software applications.
- Able to apply configuration knowledge to resolve basic to moderate business issues, identify alternatives, determine impact, and recommend optimal configuration solutions.
- Comprehensive working knowledge of managed care operational areas and managed care products in each market in which AGP operates, including current trends in the industry.
- Advanced understanding of data architecture.
- Advanced understanding of infrastructure associated with supported applications.
- Extensive knowledge of analysis techniques and standards and set analysis standards.
- Comprehensive understanding of how each department/health plan relates to the organization as a whole.

Computer Skills and Office Equipment - Advanced
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data. Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.

Spreadsheet Utilization and Management - Advanced
- Expert level of proficiency in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools. Ability to create spreadsheets in spreadsheets.

Database Utilization and Database Management - Intermediate
- Proficient in database utilization including ability to conduct queries and design databases, and perform multiple table query design. Multi table. Ability to perform general data analysis. Accounts of records of a certain type.

Systems - Expert
- Understands systems development lifecycle. Understanding of system's utilization and considered a systems SME for the following systems:
- NetworX/Facets – build pricing based on provider contracts using Facets applications. Build benefit plans based on State regulations using Facets benefit applications.
- MACESS – contracts and claim images are stored. MACESS Workflow tool for contract life-cycle.
- Software products from Ingenix for prospective payment system (PPS) – pricing.
- Clearquest is used to track projects –knowledge and familiarity using a project inventory tracking system.

Applications/Tools - Intermediate
- Ability to leverage available tools such as:
- TOAD, UltraEdit, Microsoft Project, Microsoft query analyzer SQL mgr, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity - Basic
- General healthcare, who are our providers (hospitals phy ofc, ancil) who are payors (insurance companies),
- High level claims process, knowledge of general industry how it works.
- More specific knowledge around reimbursement methodology, fee schedules. Per case, per diem, DRG, % of charges, those terms. HIPAA.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping DRG codes, place of service codes (POS).

Government Programs Specific Knowledge
- Medicare Medicaid programs, CHIP and LTC.
- Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Gather and Document Requirements - Expert
- Mentors others.
- Viewed as a SME.
- Ability to prepare the most complex requirements documents.
- Ability to facilitate requirements gathering including determining the most efficient and effective way to capture the requirements, and managing kick off and subsequent status meetings.
- Ability to manage timelines and due dates. Ability to recognize and understand business changes that impact requirements and incorporate changes into documentation.
- Ability to read and re-read requirements documents multiple times while maintaining detail orientation.

Contracts - Intermediate
- Ability to read a contract and understand the operational requirements the contract creates. Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving-Analytics - Advanced
- Ability to understand moderate to complex business process flows (complex, corporate or enterprise-wide).
- Ability to thoroughly understand, analyze and synthesize data, including relationships of data, e.g.
- Cause/effect. Ability to conduct business analysis, requirements gathering, process analysis and gap analysis.

Project Management - Advanced
- Skilled in running multiple projects utilizing standard project management tools, techniques and methodology. Keeps projects on task.

Testing - Advanced
- Advises and mentors others. Functions independently in the creation of moderate to complex test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

SCOPE INFORMATION

# Direct Reports:

# Indirect Reports: 0 – 15

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.
- Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.

CB1

ermIT
]]>http://www.amerigroup-jobs.com/job/Richmond-Business-Analyst-Principle-I-Job-VA-23173/2636864/263686426368642013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSRichmond, VA, US
Job ID 2013-23044 # Positions 1
Location US-IN-Indianapolis
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 6/6/2013
Additional Locations ..

More information about this job:
Summary:

The Manager of Quality Management is responsible in conjunction with the plan leadership for developing, coordinating, and implementing quality initiatives within the health plan. Provides process and technical supervision to a team responsible for monitoring and evaluating the quality of care/service, appropriateness, continuous improvement, member satisfaction, and results of actions across the continuum of care to members. Assist in coordinating the quality management program activities throughout the functional areas of the health plan.

Responsibilities:

1. Assists in establishing objectives and annual goals in conjunction with the plan leadership.

2. In conjunction with the plan QM leader, implements the comprehensive Quality Management Program to meet the demographic and epidemiological needs of the population served.

3. Promotes plan-wide understanding, communication, and coordination of the quality management program.

4. Manages and evaluates team’s performance and ensure adherence to department’s standards.

5. Trends quality data and develops aggregate and individual plan reports as indicated. Analyzes validity of data/reports.

6. Coordinates on a quarterly basis reporting of all quality/risk initiatives to all appropriate committees.

7. Develops, designs, implements and evaluates activities including coordination of focus studies and other indicators of quality of care/service.

8. Coordinates development, implementation, and evaluation of continuous quality improvement action plans for the improvement activities.

9. Participates in the reporting of Plan data and coordinates the improvement action plans.

10. Coordinates the state regulatory quality reporting for the health plan.

11. Provides support for provider recredentialing in the areas of medical record reviews, quality indicators and trended data.

12. Assures compliance with State and Federal quality improvement requirements. Prepares plan staff for successful State and internal audits.

13. Maintains liaison for quality initiatives with State and Federal regulatory agencies as needed.

14. Evaluates and makes recommendations for oversight of delegated services.

15. Assists in developing the annual operating and capital budgets to sufficiently meet departmental needs and ensures that department stays within budget and accounts for variances.

16. Interviews, manages, evaluates, and develops new and existing departmental staff.

17. Recognizes and utilizes appropriate channels for communication and encourages two-way communication and encourages staff to participate in creative program development.

18. Work collaboratively with key health care professionals toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problem resolution.

19. Effectively communicates information to superiors, team members, and other appropriate staff in a timely, accurate, and courteous manner.

20. Actively participates in meetings and helps maintain an effective work group.

21. Develops presentations on activities for a variety of audiences as needed.

22. Plan and execute an annual member and provider outreach plan.

23. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associates Degree or equivalent work experience.

Preferred:
- Bachelors Degree, or MSN, MPH, MPA.

Years and Type of Experience Required:

Required:
- Minimum of 5 years of current experience in quality improvement, and/or utilization review in HMO setting with at least 1 year management/leadership experience.

Preferred:
- Previous NCQA accreditation and HEDIS reporting experience.
- Experience with the urban Medicaid population.

Certifications or Licensure

Required:
- N/A

Preferred:
- Current state RN license preferred, Risk Management License preferred; CPHQ preferred.

Other:

Required:
- Strong knowledge base in areas of quality improvement.
- Excellent written and verbal communication skills.
- Ability to work effectively with physicians and other health care providers as well as with multi-disciplinary teams across department lines.
- Excellent problem solving skills.
- Demonstrates strong organizational skills.
- Knowledge of basic computers including word processing and spreadsheets.
- Ability to work in a team environment.
- Ability to develop and give presentations.
- Ability to handle multiple tasks.
- 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.

CB1

ermHO
]]>http://www.amerigroup-jobs.com/job/Indianapolis-Manager%2C-Quality-Management-Job-IN-46201/2646449/264644926464492013-07-18AmerigroupNursingfull-timeUSDstarting0BSIndianapolis, IN, US
Job ID 2013-23071 # Positions 1
Location US-IN-Indianapolis
US-NATIONWIDE
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 6/10/2013
Additional Locations US-NATIONWIDE

More information about this job:
Summary:

Under direct supervision, responsible for supporting the project managers, business analysts, or functional area leadership by coordinating project administration, reviewing, revising and maintaining critical documents required to support assigned projects. Support the functional aspects of the assigned team or department, including overall project and team administration, tracking of internal resources and expenses, process support and training, project budget management, report analysis, and project plan development and reviews.

Responsibilities:

1. Maintain required documentation including SharePoint sites, organization charts, distribution lists, meeting minutes, project logs, project schedules, requirements documents, project budgets, and status reports.

2. Provide logistics related to project management support including scheduling meetings, negotiating meeting space, room set up, meeting materials preparation and distribution, and catering as well as arranging for and testing all meeting technology such as polycom phones, WebEx, video teleconferencing, microphones or projection.

3. Works from list of tasks provided by functional area experts, existing documents and project plans, notes, and general communications to prepare and maintain an overall project plan using the selected project management tools.

4. Works with functional area experts and the project manager to develop concise, complete, accurate, and clear specifications of project deliverables for the overall project and subprojects.

5. Reviews, edits, and revises appropriate documents produced by others in support of projects.

6. Researches and develops small programs or SOPs for review and edits.

7. Assists the project manager and other team members in developing and documenting temporary operational workflows and procedures used in transitioning the business organization through implementation and ultimately go-live.

8. Reproduces, binds, and distributes project documents.

9. Assist in developing and setting publications standards for the project documentation products.

10. Acts as liaison between project team and assigned functional area for project-related communications and tasks; coordinates status reporting, monitor’s deliverable execution, etc.

11. Assist in conducting training on process, tools, and best practices for associates.

12. Participates and coordinates various workgroups related to process improvement in support of assigned projects.

13. Coordinates standard report development in support of assigned projects and the Project team.

14. Assists in maintaining relationships with external vendors in support of assigned projects and the Project team.

15. May perform additional administrative functions, to include but not limited to, travel, expense reports, delegating calendars, etc.

16. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associate’s degree or equivalent combination of education and experience.

Preferred:
- Bachelor’s Degree

Years and Type of Experience Required:

Required:
- Two years Project Coordination or Executive Administrative Assistance experience.

Preferred:
- Health care insurance industry experience.
- MS Project, Outlook, PowerPoint and Visio experience.
- Survey tools experience, e.g. Survey Monkey.

Language Skills

Required:
- English

Technical Competencies

Project Management - Basic
- Ability to plan, coordinate. Organize and lead project administration and maintain critical project documents in accordance with industry standards and best practices as established by organizations such as Project Management Institute (PMI).

Industry Knowledge & Familiarity - Basic
- General knowledge of the healthcare industry and government insurance programs, e.g. Medicare, Medicaid, CHIP and LTC.

Computer Skills and Office Equipment - Basic
- Ability to use software and hardware of a computer (e.g. Outlook, PowerPoint, etc.) to complete certain simple tasks. Able to use basic office equipment such as telephone, video teleconference equipment, fax machine and copy machine. - Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key. Use of internet, familiarity with SharePoint sites. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to open, review, edit and save data.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Indianapolis-Project-Coordinator-I-Job-IN-46201/2653488/265348826534882013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSIndianapolis, IN, US
Job ID 2013-22804 # Positions 1
Location US-IN-Indianapolis
Search Category Legal
Type Regular Full-Time (30+ hours) Posted Date 5/9/2013
Additional Locations ..

More information about this job:
Summary:

The Compliance Officer (CO) is responsible for implementing the Corporate Compliance Program (CCP) at the health plan level that serves to prevent and detect crime, to promote compliance with corporate policies and upholds an ethical culture. Additionally, the individual in this role will be responsible for developing and implementing specifically-tailored compliance education sessions to address key issues; and for designing and implementing a compliance communication strategy to keep senior management and other relevant associates informed of changes to the regulatory environment within the scope of the CCP, as well as communicating about specific compliance program initiatives throughout the year.

Responsibilities:

1. Establish scope of activities required to support the Compliance Effectiveness Review at the Plan Compliance Officer (PCO) level.

2. Lead and assure compliance training activities are completed in an effective manner.

3. Monitor health Plan Performance Standards for compliance with contractual and regulatory requirements and maintain a general focus on call center metrics, claims payments, minimum net worth and licensure of health plans and employed professional.

4. Maintain relevant Plan Policies and Procedures that may impact the Plan or Company and provide assessments to critical stakeholders and Plan senior leadership on consistency with regulatory and contractual requirements including anti-kickback statutes, timeliness of enrollment; and incentive compensation.

5. Review policies and procedures and health plan activities to ensure adherence to Business Associate requirements and physical and electronic security under HIPAA.

6. Ensure regular meetings of the Plan Compliance Committee (PCC) to discuss identification and assessment of compliance initiatives, potential risks and current state.

7. Serve as liaison to external and internal audits between business owner and state/federal entities:

a. Coordinate with OBE on preliminary investigations of potential non-compliance; maintain confidentiality as appropriate and recommend corrective action or next steps to OBE and business owners;

b. Monitor payments or contributions to providers and community and faith based organizations made by or on behalf of the health plan to ensure compliance with AGP’s policies and procedures including but not limited to charitable donations and gifts;

c. Maintain a quarterly log of marketing materials reviewed via CMAP, submitted to the governing agency and approved for use and perform monthly reviews of marketing field activities to ensure compliance;

d. Monitor and evaluate member access through review of changes in network composition and appointment guideline surveys; and

e. Verify control process used to ensure accuracy of information submitted to government agencies.

8. Establish schedule to monitor corrective actions related to issues identified at the PCC level.

9. Attend and participate in meetings where business strategy is discussed with Plan senior leadership.

10. Provide regular and ad hoc reports on activities outlined above for review by the OBE and health plan CEO/EVP.

11. Other Duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors degree from an accredited university.

Preferred:
- Masters or higher degree in Law, Business, Healthcare.

Years and Type of Experience Required:

Required:
- Minimum of 7 years relevant experience in healthcare compliance, audit or compliance, with at least 3 years of leadership/management experience.

Preferred:
- Experience in conducting or responding to government audits and investigations, and/or direct experience working in a relevant federal agency(HHS, OIG, CMS).

Specific Technical Skills

Required:
- Proficient in the use of MS Office (Visio, Excel, Access, Word).

Certifications or Licensure

Required:
- N/A

Preferred:
- CHC, Current license to practice law in at least one state, CPA or CIA.

Other:

Required:
- Excellent verbal and written communication skills; Solid analytical skills and knowledge of controls.
- Strong leadership skills with the ability to influence and manage.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 0-5

Budgetary $ Responsibility: Areas of Responsibility

PHYSICAL REQUIREMENTS
- Must be able to operate a computer and telephone.
- Travel 30% on common carriers and adhere to AMERIGROUP travel policies.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Indianapolis-Director-Compliance-Offcr-Plan-Job-IN-46201/2589880/258988025898802013-07-18AmerigroupLegalfull-timeUSDstarting0BSIndianapolis, IN, US
Job ID 2013-23078 # Positions 9
Location US-FL-Miami Lakes
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 6/11/2013
Additional Locations ..

More information about this job:
Summary:

Nursing Home - Case Manager

Responsible for conducting telephonic or face-to-face assessments for the identification, evaluation, coordination and management of Members’ needs, including physical health, behavioral health, social services and long term services and supports; develops the Member’s Individualized Service Plan to address those needs. Establishes relationships with referral sources and community resources, while maintaining strict member confidentiality and complying with all HIPAA requirements.

Responsibilities:

1. Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team.

2. Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members’ health care needs while optimizing efficiency and quality outcomes.

3. Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member’s PCP or treating physician and specialists in the development of an Individual Service Plan.

4. Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.

5. Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member’s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.

6. Reviews benefit options, acquires data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors degree from an accredited college or university in Nursing, Social Work, Counseling, Special Education, Sociology, Psychology, Gerontology, or a closely related field, State Waiver (NM), or a minimum of six years of experience working for State agencies directly or by contract.
- Bachelors Degree in an unrelated field and at least two years of geriatric experience

Preferred:
- Masters degree from an accredited college or university in Nursing, Social Work, Counseling, Special Education, Sociology, Psychology, Gerontology, or a closely related field.

Years and Type of Experience Required:

Required:
- Minimum of two years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role.

Preferred:
- Experience in home health, health care, discharge planning, behavioral health, collaborating with nursing facilities, community resources, and/or other home and community-based agencies.
- Experience working with Medicare, Medicaid, and managed care programs.

Certifications or Licensures

Required:
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.
- Additional state mandated certification, where appropriate.

Language Skills

Required:
- English

Preferred:
- Bilingual (ability to read, write, and speak).

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with case or utilization management data systems.
- Solid understanding of the healthcare industry and government insurance programs.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Miami-Lakes-Case-Manager-Nursing-Home-Miami-Job-FL-33014/2656527/265652726565272013-07-18AmerigroupCase Managementfull-timeUSDstarting0BSMiami Lakes, FL, US
Job ID 2013-22982 # Positions 1
Location US-FL-Miami Lakes
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/30/2013
Additional Locations ..

More information about this job:
Summary:

Broward - Provider Relations Rep II

Bilingual (English/Spanish) required

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.

Responsibilities:

1. Track andrespond 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.

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

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

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

11. Performs other duties and special projects as assigned.

Qualifications:

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.

Certifications or Licensures

Required:
- Valid Driver’s License

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.

ermCS
]]>http://www.amerigroup-jobs.com/job/Boca-Raton-Provider-Relations-Rep-Broward-Job-FL-33427/2629933/262993326299332013-07-18AmerigroupCustomer Servicefull-timeUSDstarting0BSMiami Lakes, FL, US
Job ID 2013-22848 # Positions 1
Location US-FL-Miami Lakes
Search Category Healthcare Management Services
Type Regular Full-Time (30+ hours) Posted Date 5/14/2013
Additional Locations ..

More information about this job:
Summary:

Case Manager - LTC - South Florida

Responsible for conducting telephonic or face-to-face assessments for the identification, evaluation, coordination and management of Members’ needs, including physical health, behavioral health, social services and long term services and supports; develops the Member’s Individualized Service Plan to address those needs. Establishes relationships with referral sources and community resources, while maintaining strict member confidentiality and complying with all HIPAA requirements.

Responsibilities:

1. Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team.

2. Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members’ health care needs while optimizing efficiency and quality outcomes.

3. Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member’s PCP or treating physician and specialists in the development of an Individual Service Plan.

4. Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.

5. Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member’s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.

6. Reviews benefit options, acquires data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors degree from an accredited college or university in Nursing, Social Work, Counseling, Special Education, Sociology, Psychology, Gerontology, or a closely related field, State Waiver (NM), or a minimum of six years of experience working for State agencies directly or by contract.
- Bachelors Degree in an unrelated field and at least two years of geriatric experience

Preferred:
- Masters degree from an accredited college or university in Nursing, Social Work, Counseling, Special Education, Sociology, Psychology, Gerontology, or a closely related field.

Years and Type of Experience Required:

Required:
- Minimum of two years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role.

Preferred:
- Experience in home health, health care, discharge planning, behavioral health, collaborating with nursing facilities, community resources, and/or other home and community-based agencies.
- Experience working with Medicare, Medicaid, and managed care programs.

Certifications or Licensures

Required:
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.
- Additional state mandated certification, where appropriate.

Language Skills

Required:
- English

Preferred:
- Bilingual (ability to read, write, and speak).

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with case or utilization management data systems.
- Solid understanding of the healthcare industry and government insurance programs.

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.


]]>http://www.amerigroup-jobs.com/job/Boca-Raton-Case-Manager-Boca-Raton-Job-FL-33427/2597176/259717625971762013-07-18AmerigroupHealthcare Management Servicesfull-timeUSDstarting0BSMiami Lakes, FL, USKeywords:
Call Center, Customer Service, CSR, Representative, Healthcare, Managed Care, Agent, Bilingual Spanish

Summary:

The Tampa Contact Center, with operations in Tampa, FL, delivers a variety of support resources to members of Amerigroup's Southern Region Health Plans.

Associates are focused on understanding and meeting the needs of our customers by connecting with the mission and vision in their daily work activity. While working with our customers over the phone, Customer Care associates use their analytical skills to identify issues and proactively engage to solve problems during the call. While anticipating the needs of our customers, Customer Care associates demonstrate good listening skills, strong verbal and written communication skills to help influence our customers resulting in an amazing customer experience.

If you are looking for a way to make a difference in the lives of others by offering a little help to those in need, you are invited to further explore employment opportunities at Amerigroup.

Responsible for responding to either inbound inquiries or outreach calls from/to potential and existing AMERIGROUP members and providers. Under general supervision, associates will provide information over the phone to members, providers, billing agencies and prospective members regarding products, claims inquiries, eligibility, benefits and/or authorizations. Associates will initiate outbound and/or handle inbound calls to current members to resolve issues and provide information. Associates will research moderately complex inquiries and clearly communicates information to caller.

This position is located in Tampa, FL.
We are recruiting for a training classes to start August 5.

BILINGUAL SPANISH CANDIDATES WILL BE GIVEN FIRST PRIORITY

Responsibilities:
1. Provides telephonic assistance to members, providers, prospective members and others regarding benefits, claims status, eligibility, product information, enrollment and/or other customer service inquiries.
2. Identifies customer concerns, recommend solutions, and facilitate resolution of the issues.
3. Prepares correspondence, maintains phone and contact logs, and documents call details as appropriate.
4. Submits member enrollment documentation in accordance with guidelines, as assigned.
5. Conducts outbound call campaigns to inform members of available benefits and conduct surveys to assess the quality of services rendered.
6. Provides pleasant customer experience through superior service and real-time customer issue resolution.
7. Maintains knowledge of assigned products/markets and the applicable state and federal regulations.
8. Follows departmental processes and policies when resolving customer issues.
9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education
Required:
• High school diploma or GED
Preferred:
• Some completed college courses in health care, business or related field.

Years and Type of Experience
Required:
• Four years of customer service or call center experience.
Preferred:
• Managed care experience

• Medicaid and/or Medicare experience

Certifications or Licensures
Required:
• N/A

Language Skills
Required:
• English
Preferred:
• Spanish
• Other languages as determined by business need.

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment-Intermediate
• Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
• Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
• Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.
Communication Skills: Verbal, Written and Call Handling
• Ability to use proper language, grammar and style in the preparation of verbal and written messages to convey a clear, concise, friendly and appropriate message to business partners and customers.
• Demonstrates skills to properly handle a telephone inquiry into the contact center. Properly greet the customer and provide information based on purpose for the call and script requirements.
• Ability to prepare, edit and convey a variety of messages including presentations, training materials and updates.
• Ability to handle escalated issues to diffuse concerns through verbal and written messages.

Heath Care Industry Terminology
• Ability to understand basic health care industry terms, e.g. managed care, primary care physician, explanation of benefits, etc.

Read, Interpret and Apply Information
• Ability to read and comprehend the information and provide an explanation to the business partner or customer that is accurate and appropriate.
• Ability to research information using available resources.

Medical Terminology and Anatomy
• Understand basic medical terminology in order to review and understand claim information.
Behavioral Competencies

Strategic Leadership
Be Strategic

• Demonstrates understanding of the organization's mission and strategies.
• Works to clarify and understand the broader purpose and mission of own work.
• Integrates and balances big-picture concerns with day-to-day activities.
• Generates innovative ideas and solutions to problems.
• Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions

• Approaches problems with curiosity and open-mindedness.
• Collects sufficient information to understand problems and issues.
• Analyzes problems and issues from different points of view.
• Applies accurate logic and common sense in making decisions

People Leadership
Develop/Support Organizational Talent

• Relates to people in an open, friendly, and accepting manner.
• Treats others with respect.
• Listens carefully and attentively to others’ opinions and ideas.
• Maintains positive relationships even under difficult or heated circumstances.
• Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration

• Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
• Appropriately involves others in decisions and plans that affect them.
• Provides honest, helpful feedback to others on their performance.
• Shares own experience and expertise with others.

Results Leadership
Show Drive and Initiative

• Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
• Maintains a consistent, high level of productivity.
• Takes personal responsibility to make decisions and take action.
• Does not easily give up in the face of unexpected obstacles.
• Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution

• Juggles many priorities and competing demands for one's time.
• Acts resourcefully to ensure that work is completed within specified time and quality parameters.
• Removes obstacles in order to move the work forward and/or get efforts back on track.
• Surfaces problems and issues before projects get derailed.

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 travel as needed and adhere to Amerigroup travel policies and procedures.CB1http://www.amerigroup-jobs.com/job/Tampa-Medicare-DSU-Customer-Care-Rep-II-BILINGUAL-SPANISH-FL-33607/2665705/266570526657052013-07-18Amerigroupfull-timeUSDstarting0BSTampa, FL USAKeywords:
Call Center, Customer Service, CSR, Representative, Healthcare, Managed Care, Agent, Bilingual Spanish

Summary:

The Tampa Contact Center, with operations in Tampa, FL, delivers a variety of support resources to members of Amerigroup's Southern Region Health Plans.

Associates are focused on understanding and meeting the needs of our customers by connecting with the mission and vision in their daily work activity. While working with our customers over the phone, Customer Care associates use their analytical skills to identify issues and proactively engage to solve problems during the call. While anticipating the needs of our customers, Customer Care associates demonstrate good listening skills, strong verbal and written communication skills to help influence our customers resulting in an amazing customer experience.

If you are looking for a way to make a difference in the lives of others by offering a little help to those in need, you are invited to further explore employment opportunities at Amerigroup.

Responsible for responding to either inbound inquiries or outreach calls from/to potential and existing AMERIGROUP members and providers. Under general supervision, associates will provide information over the phone to members, providers, billing agencies and prospective members regarding products, claims inquiries, eligibility, benefits and/or authorizations. Associates will initiate outbound and/or handle inbound calls to current members to resolve issues and provide information. Associates will research moderately complex inquiries and clearly communicates information to caller.

This position is located in Tampa, FL.
We are recruiting for a training classes to start August 5.

Responsibilities:
1. Provides telephonic assistance to members, providers, prospective members and others regarding benefits, claims status, eligibility, product information, enrollment and/or other customer service inquiries.
2. Identifies customer concerns, recommend solutions, and facilitate resolution of the issues.
3. Prepares correspondence, maintains phone and contact logs, and documents call details as appropriate.
4. Submits member enrollment documentation in accordance with guidelines, as assigned.
5. Conducts outbound call campaigns to inform members of available benefits and conduct surveys to assess the quality of services rendered.
6. Provides pleasant customer experience through superior service and real-time customer issue resolution.
7. Maintains knowledge of assigned products/markets and the applicable state and federal regulations.
8. Follows departmental processes and policies when resolving customer issues.
9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education
Required:
• High school diploma or GED
Preferred:
• Some completed college courses in health care, business or related field.

Years and Type of Experience Required:
Required:
• Four years of customer service or call center experience.
Preferred:
• Managed care experience

• Medicaid and/or Medicare experience

Certifications or Licensures
Required:
• N/A

Language Skills
Required:
• English
Preferred:
• Spanish
• Other languages as determined by business need.

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment-Intermediate
• Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
• Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
• Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.
Communication Skills: Verbal, Written and Call Handling
• Ability to use proper language, grammar and style in the preparation of verbal and written messages to convey a clear, concise, friendly and appropriate message to business partners and customers.
• Demonstrates skills to properly handle a telephone inquiry into the contact center. Properly greet the customer and provide information based on purpose for the call and script requirements.
• Ability to prepare, edit and convey a variety of messages including presentations, training materials and updates.
• Ability to handle escalated issues to diffuse concerns through verbal and written messages.

Heath Care Industry Terminology
• Ability to understand basic health care industry terms, e.g. managed care, primary care physician, explanation of benefits, etc.

Read, Interpret and Apply Information
• Ability to read and comprehend the information and provide an explanation to the business partner or customer that is accurate and appropriate.
• Ability to research information using available resources.

Medical Terminology and Anatomy
• Understand basic medical terminology in order to review and understand claim information.
Behavioral Competencies

Strategic Leadership
Be Strategic

• Demonstrates understanding of the organization's mission and strategies.
• Works to clarify and understand the broader purpose and mission of own work.
• Integrates and balances big-picture concerns with day-to-day activities.
• Generates innovative ideas and solutions to problems.
• Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions

• Approaches problems with curiosity and open-mindedness.
• Collects sufficient information to understand problems and issues.
• Analyzes problems and issues from different points of view.
• Applies accurate logic and common sense in making decisions

People Leadership
Develop/Support Organizational Talent

• Relates to people in an open, friendly, and accepting manner.
• Treats others with respect.
• Listens carefully and attentively to others’ opinions and ideas.
• Maintains positive relationships even under difficult or heated circumstances.
• Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration

• Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
• Appropriately involves others in decisions and plans that affect them.
• Provides honest, helpful feedback to others on their performance.
• Shares own experience and expertise with others.

Results Leadership
Show Drive and Initiative

• Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
• Maintains a consistent, high level of productivity.
• Takes personal responsibility to make decisions and take action.
• Does not easily give up in the face of unexpected obstacles.
• Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution

• Juggles many priorities and competing demands for one's time.
• Acts resourcefully to ensure that work is completed within specified time and quality parameters.
• Removes obstacles in order to move the work forward and/or get efforts back on track.
• Surfaces problems and issues before projects get derailed.

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 travel as needed and adhere to Amerigroup travel policies and procedures. cb1
]]>http://www.amerigroup-jobs.com/job/Tampa-Medicare-DSU-Customer-Care-Rep-II-FL-33607/2671789/267178926717892013-07-18Amerigroupfull-timeUSDstarting0BSTampa FL USA
Job ID 2013-23094 # Positions 1
Location US-VA-Virginia Beach
Search Category Health Care Administration
Type Regular Full-Time (30+ hours) Posted Date 6/12/2013
Additional Locations ..

More information about this job:
Summary:

The Coordinator of Appeals and Grievances (MCAG) is responsible for the intake, routing and coordination of the Medicare Member Complaints, Appeals & Grievances (CAGs) as well as Non-Participating Provider Appeals & Payment Disputes received within the department. In addition, the MCAG Coordinator is responsible for the processing of non-clinical MCAGs in accordance with the requirements as set forth by the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Program.

Responsibilities:

1. Medicare Member Appeal Processing: The review of adverse organization determinations (denials of service or payment) issued by Amerigroup.

2. Medicare Member Grievance Processing: A review of a member’s expression of dissatisfaction with any aspect of the plan’s or contracted provider’s operations, activities, or behavior.

3. Responsible for the intake and acknowledgement of all MCAGs received in MCAG Department through all intake portals, data entry, and administrative responsibilities (acknowledge, file creation, routing, obtaining required documentation, etc.) ensuring proper logging for all regulatory reporting requirements and timely rerouting of issues.

4. Responsible for processing of all non-clinical Medicare Complaints, Appeals & Grievances under both the Part C and Part D Medicare programs for all markets, ensuring compliance with all regulatory mandated timeframes and requirements, which may require: direct member (and our authorized Representative) and provider contact.

5. Accessing/updating internal and external CMS systems for eligibility and information needed to process and document AGP resolution.

6. Processing of complaints lodged through 1-800-MEDICARE.

7. Case file documentation in accordance with department policy to ensure completion with internal Medicare Compliance & CMS auditing.

8. Analyze research and resolve appeal requests through review of benefit design, eligibility, care management procedures, obtaining medical records and claims payment review. May include review of case files with Clinical Staff (up to and including SSO Medical Director)

9. Processing of CAGs through any mandated process including the Independent Review Organization contracted by the Centers for Medicare & Medicaid Services (CMS) and file preparations for hearings before Administrative Law Judges (ALJ), review by the Medicare Appeals Council (MAC) and judicial review.

10. Processing of all Non-Participating Provider Appeals & Payment Disputes for all markets, ensuring compliance with all regulatory mandated timeframes and requirements. This includes claims review to determine appropriateness of payment and review through the Independent Review Organization contracted by CMS to review AGP decisions.

11. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High School Diploma.

Preferred:
- Bachelors Degree

Years and Type of Experience Required:

Required:
- Minimum of 1year experience supporting the Medicare program: Parts C (Medicare Advantage) & Part D (Medicare Prescription Drug).

Preferred:
- Medicare claims processing a plus.

Specific Technical Skills

Required:
- Proficient with MS Office (Word, Excel, Outlook).

Other:

Required:
- Excellent verbal and written communication skills with the ability to interface with providers, members and agencies about the denial and appeal process.
- Knowledgeable of Federal guidelines and regulations (Medicare Advantage Program).
- Problem-solving abilities in support of internal and external customers.
- Detail-oriented.
- Self-disciplined and self-motivated.
- Ability to prioritize, juggle multiple cases and caseloads to ensure compliance.
- Knowledge of benefit plan yearly updates: COB, Medicaid program coverage for dual eligible members, Pharmacy (Part D Prescription Drug Benefit) coverage, formulary and access requirements.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Medicare-Coordinator-Appeals-&-Grievances-Job-VA-23450/2659657/265965726596572013-07-18AmerigroupHealth Care Administrationfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-23053 # Positions 1
Location US-VA-Virginia Beach
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 6/11/2013
Additional Locations ..

More information about this job:
Summary:

Under general supervision, licensed clinician responsible for day to day telephonic medical management and pre-authorization activities. Manages member care ensuring essential, effective, appropriate and coordinated behavioral and physical health and social services. Acts as a member advocate, seeking and coordinating solutions to member health care needs.

Responsibilities:

1. Provides telephonic and faxed advice and education on the pre-authorization process to providers.

2. Maintains and utilizes working relationships with and knowledge of referral sources and community resources.

3. Adheres to all company and state policies, accreditation standards and regulatory guidelines.

4. Utilizes the application of medical management criteria or other company designated criteria.

5. Acts as a clinical resource to other internal departments.

6. Communicates to assigned supervisor or leads all cases needing a higher level of intervention.

7. Documents all pre-certifications and authorization requests as well as all required encounters utilizing the appropriate systems and resources.

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

9. Collaboratively works with other departments.

10. Participates in Quality Improvement processes.

11. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma, or
- Associate’s Degree in related Health/Nursing Field

Preferred:
- Bachelor’s or Master’s Degree in Nursing or related Health/Nursing Field

Years and Type of Experience Required:

Required:
- 2 Years experience as a licensed RN, or
- 3 years experience as a licensed LPN/LVN in the Health Care or Managed Care Industry

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

Certifications or Licensures

Required:
- Active licensed LVN or LPN

Preferred:
- Active licensed RN

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment - Intermediate
- Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.

Communication Skills - Verbal, Written and Call Handling
- Ability to use proper language, grammar and style in the preparation of verbal and written messages to convey a clear, concise, friendly and appropriate message to business partners and customers.
- Skills to properly handle a telephone inquiry into the contact center. Properly greet the customer and provide information based on purpose for the call and script requirements.
- Ability to prepare, edit and convey a variety of messages including presentations, training materials and updates. Ability to handle escalated issues to diffuse concerns through verbal and written messages.

Heath Care Industry Terminology
- Ability to understand basic health care industry terms. Ability to understand how an insurance claim works and use the explanation of benefits to explain details to providers.

Read, Interpret and Apply Information
- Ability to read and comprehend information and provide detailed explanation to the business partner or customer that is accurate and appropriate.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.

Medical Terminology and Anatomy
- Understand medical terminology to review clinical certifications. Hands on clinical skills to understand the workings of the human body to review and apply clinical criteria to certifications.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Supervisor-Med-Mgmt-NCC-Nurse-Job-VA-23450/2656526/265652626565262013-07-18AmerigroupNursingfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-23109 # Positions 1
Location US-VA-Virginia Beach
US-NJ-Iselin
Search Category Legal
Type Regular Full-Time (30+ hours) Posted Date 6/13/2013
Additional Locations US-NJ-Iselin

More information about this job:
Summary:

Under limited supervision, conduct in-depth investigations of reported, alleged or suspected fraud, waste and abuse involving providers, members, and associates for the full range of products at Amerigroup. Ensure compliance with contractual requirements related to Corporate Investigations Department (CID) and fraud, waste and abuse investigations. Mentors and provides guidance to others in the unit. Develops and maintains working relationships with appropriate Health Plans, departments and outside agencies.

Responsibilities:

1. Maintains full investigative moderate to complex case load by conducting investigations into reported, alleged or suspected fraud, waste and abuse.

2. Independently decides the most effective and efficient method of investigation for each individual case. Prepares and documents investigative plans detailing the investigative plan of action according to department guidelines.

3. Proactively and independently analyzes data using available fraud detection software and corporate resources to identify new cases and as part of the investigative process.

4. Performs out-of-office field investigation, as appropriate.

5. Develops sufficient evidence to conclusively establish facts.

6. Independently conducts and documents comprehensive interviews/interrogations with providers, members, associates and witnesses to obtain information which would be considered admissible under generally accepted criminal and civil rules of evidence.

7. Prepares and submit findings and make recommendations to management.

8. Manages assigned cases and continuously updates the department’s Case Management System, along with the physical and on-line case files, with pertinent case details.

9. Testifies in criminal and civil legal proceedings as required.

10. Works in collaboration with the Medical Directors, Quality Management, Clinical Review specialist, and Certified Professional Coders (CPC) in order to quantify and qualify properly identified overpayment amounts.

11. Utilizes the Rats Stats application to properly identify the accepted legal sample(s) and overpayment that may have to be reproduced in the judicial arena.

12. Represents Amerigroup in conducting settlement negotiations with providers, counsel and/or other associated parties.

13. Prepares, collects, organizes, develops and submits any and all documentation in accordance with required State and Federal audits.

14. Prepares, documents, and submits required monthly/quarterly reports to identified state agencies, upper management within Amerigroup and federal agencies, if requested.

15. Establishes and maintains working relationships with all appropriate law enforcement and regulatory personnel, and industry peers including FBI, Attorney General’s Office, Departments of Insurance, State Special Investigations Units, NHCAA and other managed care organizations in their respective markets.

16. Develops and maintains close working relationships with all internal departments and senior management in the health plan(s) to which they are assigned including CEOs, Chief Compliance Officers, Medical Directors, Provider Relations, and Claims etc.

17. Develops and maintains working relationships with Amerigroup vendors relating to coordinating investigations.

18. Represents Amerigroup at meetings with state agencies, law enforcement, and other out side entities.

19. Conducts special studies for management such as those required to determine compliance with new provider contracts, laws or regulations.

20. Develops and presents fraud awareness training sessions.

21. Provides consultation to Investigators where high level technical expertise is necessary. Assists with training, and educating other associates in the department.

22. Participates in identifying new initiatives and/or projects that will identify and reduce fraud, waste and abuse, to include pre-disbursement and post payment.

23. Participates in the preparation of responses related to the development of Request for Proposals, Expansion Applications and Readiness Reviews in new Markets.

24. Assists in the evaluation, design and implementation of strategies to flag and evaluate claims of certain providers who are billing beyond norms prior to disbursement of payments. Additionally, assist in sending communications/training to providers regarding billing beyond norms and monitor impact on future billing patterns.

25. Continuously identifies opportunities to reengineer current practices (process improvement).

26. Performs other duties as assigned/requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree or equivalent work experience accepted in lieu of education.

Years and Type of Experience Required:

Required:
- Minimum 5 years experience in the field of Criminal Justice, Business, Insurance, Medical Insurance Claims, Clinical or other related field.

Preferred:
- Minimum 5 years experience conducting health care or white collar crime investigations interacting with state, federal and local law enforcement agencies with law enforcement experience and/or clinical experience.

Certifications or Licensures

Preferred:
- Accredited Health Care Fraud Examiner (AHFI)
- Certified Fraud Examiner (CFE)

Language Skills

Required:
- English

Functional Competencies
- Intermediate to Advanced Level of MS Office skills.
- AMISYS, FACETS or related claims processing system preferred.
- Understanding of CMS 1500 and UB04 claim billing forms.
- Advanced understanding of common claim coding (CPT-4, ICD-9, HCPCS)
- Knowledge of Medicare and Medicaid insurance law, federal, state, civil and criminal statutes.

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 travel as needed (approximately 25%) and adhere to Amerigroup travel policies and procedures.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Senior-Investigator-Job-VA-23450/2662598/266259826625982013-07-18AmerigroupLegalfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-23104 # Positions 1
Location US-VA-Virginia Beach
US-NV-Las Vegas
Search Category Legal
Type Regular Full-Time (30+ hours) Posted Date 6/13/2013
Additional Locations US-NV-Las Vegas

More information about this job:
Summary:

Under general direction:
- Manages small scale new market/new product development projects or segments of larger scale development projects in support of Amerigroup’s (AGP’s) strategic growth and development initiatives; or
- Manages the regulatory services program of a single operational market. Supports AGP’s compliance with the regulatory and contractual obligations of multiple state and federal regulatory bodies. Serves as a liaison with state regulators, and the primary communication vehicle for educating Corporate /Health Plan management staff on regulatory/contractual requirements, operational or implementation issues, and recommended actions to develop or support compliant activity by active management of the full spectrum of the market’s regulatory activities required for successful “go-live” or ongoing operations. Manages the day to day activities of assigned team members.

Responsibilities:

1. Develop and manage the regulatory services program for a single operational market. Lead activities in support of AGP’s understanding of and compliance with federal and state regulatory requirements, contractual obligations that AGP is subject to as a licensed Managed Care Organization and state contractor.

2. Operate as the internal subject matter expert in the education of health plan and corporate staff on market and product specific regulatory and contractual requirements.
- Participate as a key member of health plan senior management teams and/or implementation teams for development projects.
- Provide key stakeholders with information and resource tools to promote informed and strategic decision making and planning.
- Actively participate in a broad spectrum of health plan and corporate initiatives and workgroups to resolve operational issues to include enrollment, benefit configuration, call metrics, authorizations, high dollar claims, pended claims, appeals, and policy issues.

3. Serve as primary company representative for state regulatory agencies and personnel –
- Act as a key contact for the state and internally manage all state submissions for development projects or ongoing operations including but not limited to: regulatory filings, AGP requests for clarification on operational requirements, proposed corrective action plans, and responses to state agency requests for information.
- Develop and maintain productive working relationships with key regulators charged with initial application review/licensing approval, contract administration, and ongoing regulatory oversight of AGP to ensure effective state agency/company collaboration benefiting AGP development opportunities and ongoing operations.

4. Research and document licensing and operational requirements, developing and/or maintaining customer-focused resource tools for the purpose of associate education, executive decision-making and compliance assessments to support the implementation and maintenance of compliant business operations (i.e., State Requirements Grids, reporting grids, Alerts, Contract Summaries and SharePoint work sites).

5. Develop and maintain effective and ongoing working relationships with key health plan and corporate staff which may include, but are not limited to, Health Plan CEO/COO, Plan Compliance Officer(s), Government Relations staff, and Implementation staff. Interfaces with senior management to promote contract/regulatory compliance, address key regulatory issues and strategize for successful resolution to achieve department and company goals.

6. Research and document licensing requirements and subsequently manage the preparation, submission and approval process of the initial licensure and certification applications or renewal filings necessary for market entry or ongoing health plan operations (Certificate of Authority, Third Party Administrator, Utilization Review Agent).
- Ensure regulatory requirements are defined;
- Identify/attain agreement on business owner accountability for deliverables;
- Review application content for compliance with state specific requirements; and
- Project manages the application submissions and revisions through the regulatory approval process.

7. Lead/co-lead the review, preparation and submission of desktop audit and readiness review materials required for new contract implementations or scheduled operational audits.
- Meeting same criteria as listed in responsibility #6 above;
- Active participant in audit preparations and on-site regulatory agency reviews;
- Active participant in developing responses and corrective action plans to identify deficiencies.

8. Lead the review, assessment, communication and understanding of new or revised state regulations, state Medicaid/CHIP contracts and amendments and other state issued guidance material and leads/supports implementation activity.
- Manage the state contact execution, amendment and renewal process, including the coordination and submission of required documentation and certifications necessary for state approval.

9. Support the development of AGP proposals for new markets and products or reprocurements of existing business through the review of proposal drafts and preparations of regulatory deliverables for inclusion in the proposal(s), as applicable.

10. Oversee the state complaint coordination process, as applicable:
- Monitor the volume, trends and other pertinent information related to complaints received from state regulatory agencies;
- Ensure complaints are tracked, triaged and resolved in a timely and comprehensive manner; and
- Provide review and approval of response documentation prior to state agency submission.

11. Oversee regulatory filings of marketing/advertising materials, member correspondence, outreach programs and other collateral documents and items -
- Review and assess collateral documents for compliance with market or product specific guidelines as a primary reviewer in the Collateral Material Approval Process; and
- Negotiate approvals by state regulatory liaisons as may be necessary.

12. Manage and coordinate the activities of support staff, provide leadership and motivation by establishing clear expectations and communicating specific performance feedback.Provide training and support to team members.

13. Perform other duties as assigned or requested.

Qualifications:

Education

Required:

Bachelor’s degree or equivalent combination of EDUCATION AND EXPERIENCE required.

Years and Type of Experience Required:

Required:

Minimum of 5 years relevant work experience and 1 year of leadership/management experience.

Preferred:

Minimum of 5 years relevant work experience with at least 2 years of managed care industry experience and 1 year of leadership/management experience.

Language Skills

Required:

English

Functional Competencies:
- Intermediate level of MS Office skills; specifically MS Word and Excel
- Strong Internet research skills
- Experience with Microsoft Access database development and maintenance
- Experience with Microsoft Share point page design and maintenance
- Experience with Microsoft Project
- Experience with legal/regulatory databases or search engines

SCOPE INFORMATION
- # Direct Reports: 1-2
- # Indirect Reports: 1+

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

ermCorp
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Manager-Regulatory-Services-Job-VA-23450/2662601/266260126626012013-07-18AmerigroupLegalfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-23048 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 6/6/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for functional area and its interrelation with other areas in the capacity of gathering requirements, performing analysis, supporting the development and testing processes of assigned functional area and incorporating the applications, data, and associated technologies for supported areas. Analyzes and reports on complex business problems to be solved with automated systems or other resources. Provide 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 business applications and procedures. Provide consultation to users in the area of automated systems and department processes and less experienced business analysts. Researches, plans, coordinates and recommends software and system choices to meet the company’s business requirements. Utilizes knowledge and skills to address business challenges to improve efficiency and decision making, reduce redundancy, and enhance business results.

Responsibilities:

1. Perform detailed requirements gathering, analysis, and process and data flow diagramming for simple processes of moderate complexity, considering the relationship between processes. Identify risks and multiple solutions.

2. Evaluate and test complex new/modified programs, applications and/or operating systems to ensure adherence to operational specifications. Monitor system and business functionality and performance. Document and track product defects. Coordinate problem resolution with development and/or product vendors.

3. Work with business owners to analyze requirements and processes and with Information Technology as an advocate to ensure quality and timeliness of systems/project deliverables.

4. Use Standard Development Life Cycle (SDLC) methods or industry best practices. Understand strategic alignment of configuration solutions with business objectives.

5. Recommend improvements to existing procedures and business processes. Influence others to follow existing procedures.

6. Read and interpret a design document.

7. Read and interpret conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

8. Design moderately complex system configuration based upon business requirements ensuring optimization of auto-adjudication. Draft and maintain design documentation for all projects.

9. Configure all approved system changes and settings.

10. Use appropriate methods to resolve moderately complex design issues.

11. Develop and run moderately complex queries and reports for business analysis and trends. Perform data base updates.

12. Write, revise, and verify test plans for moderately complex systems in a software application.

13. Ensure compliance of current license and support agreements and requirements are met.

14. Manage multiple priorities at the same time.

15. Functions as a liaison for IT and the business and other cross functional resources and departments.

16. Lead cross-functional linked teams to address business or systems issues.

17. Mentor and lead less experienced BAs and functional area associates.

18. Manage project related budgets.

19. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience in a Business or Systems Analyst role is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Five years experience in systems analysis, or business analysis.

Preferred:
- Health Care industry experience.

Certifications or Licensures

Preferred:
- CBAP (Certified Business Analyst Professional)

Language Skills

Required
- English

Technical Competencies
- Advanced understanding of the inter-relationship among various IT applications and systems.
- Advanced proficiency with all applicable company supported software applications.
- Advanced understanding of how each department/health plan relates to the organization as a whole.
- 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 advanced knowledge of current technology trends.
- Able to develop and maintain customer relationships.

Computer Skills and Office Equipment - Intermediate
- Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks.
- Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard.
- Use of internet.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.

Spreadsheet Utilization and Management - Intermediate
- Proficient in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools.

Database Utilization and Database Management - Intermediate
- Proficient in database utilization including ability to conduct queries and design databases, and perform multiple table query design.

Systems - Advanced
- Thorough understanding of system's utilization and considered a systems’ SME for the following systems:
- NetworX/Facets – build pricing based on provider contracts using Facets applications. Build benefit plans based on State regulations using Facets benefit applications.
- MACESS – contracts and claim images are stored. MACESS Workflow tool for contract life-cycle.
- Software products from Ingenix for prospective payment system (PPS) – pricing.
- Clearquest is used to track projects –knowledge and familiarity using a project inventory tracking system.

Applications/Tools - Intermediate
- Leverage available tools such as: TOAD, UltraEdit, Microsoft Project, Microsoft query analyzer SQL mgr, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity - Basic
- General understanding of the healthcare industry including, how the industry works, how claims are paid, who are providers (hospitals phy ofc, ancil), and who are payors (insurance companies).

Gather and Document Requirements - Intermediate
- Ability to prepare simple to moderately-complex requirements documents.
- Ability to facilitate requirements gathering including determining the most efficient and effective way to capture the requirements, and managing kick off and subsequent status meetings.
- Ability to manage timelines and due dates.
- Ability to recognize and understand business changes that impact requirements and incorporate changes into documentation.
- Ability to read and re-read requirements documents multiple times while maintaining detail orientation.

Contracts - Intermediate
- Ability to read a contract and understand the operational requirements the contract creates. Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving-Analytics

Demonstrate the ability to seek alternatives, new ideas, and/or approaches to problems. Advanced understanding of the strategic alignment of IT solutions with business objectives. Able to initiate conceptual ideas with practical applications.

Project Management - Intermediate
- Skilled in running a project utilizing standard project management tools, techniques and methodology. Keeps project on task.

Testing - Intermediate
- Functions independently in the creation of simple to moderately-complex test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Systems-Business-Analyst-III-Job-VA-23450/2646453/264645326464532013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22383 # Positions 1
Location US-MD-Hanover
Search Category Sales & Marketing
Type Regular Full-Time (30+ hours) Posted Date 3/25/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for growing membership through educating and servicing the Medicaid population; including meeting the communities need for ongoing educational and social service outreach to existing and potential members.

***Bilingual (English/Spanish) reading, writing and speaking skills desired.

Responsibilities:

1. Acts as service representative for assigned projects and acts as a resource to the membership and the community as needed.

2. Ensure consistent compliance with all state, federal and Amerigroup specific requirements.

3. Assist with establishing and maintaining positive relationships with community organizations, provider offices, faith based organizations and perform other activities to enhance Amerigroup’s presence in the community.

4. Conducts presentations, staff exhibits and perform other activities in an effort to maintain and establish positive relationships with providers, community and faith based organizations.

5. Identify and collect educational material on community networks and advocacy groups with similar missions and values and communicate the information to management.

6. Provides telephonic assistance, outreach and/or guidance to members and potential members regarding benefit and enrollment questions, and/or providing assistance on any social service needs.

7. Assists potential and existing members with the enrollment or recertification process, where appropriate and compliant with local market regulations.

8. Supports health education activities and referral of members to health education programs.

9. Represents Amerigroup at community organizations and events such as promotions, enrollment events (where appropriate and compliant with local market regulations.) and health fairs.

10. Identifies cultural issues regarding current and potential members and communicates those issues and concerns to management.

11. Assists with retention activities necessary to ensure resolution to members around continuity of care issues.

12. Assists with activities necessary to ensure resolution to potential members around continuity of care issues.

13. May be required to drive COV per plan requirements.

14. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High School

Preferred:
- Associates Degree or BS/BA degree.

Years and Type of Experience Required:

Required:
- 1 yr experience in healthcare or sales/marketing environment.

Certifications or Licensures

Required:
- Must possess a valid driver’s license and have access to a motor vehicle and must possess valid motor vehicle insurance.

Preferred:
- Valid state health insurance licensure.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Basic
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment, in particular with Word and Excel, to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Experience working with SalesForce.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.

Read, Interpret and Apply information - Basic
- Ability to read, comprehend and interpret complex information to provide accurate and appropriate information to business partner or customer.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
- Ability to understand when to escalate erroneous/inconsistent information discovered in resources to appropriate level of management for review.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies. - Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

Other:
- Able to present information verbally, and in writing, in a concise and effective manner.
- Demonstrate ownership skills when handling internal or external customer concerns or issues.
- Able to identify problems and develop satisfying solutions.
- Demonstrates motivation and innovation for self-improvement.
- Demonstrates basic understanding of healthcare industry.
- Demonstrates knowledge of how position is related to unit/team within a department.
- Able to participate in teams as a strong team participant.

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 lift 25 pounds or more.
- Must be able to sit for long periods of time.

ermSM
]]>http://www.amerigroup-jobs.com/job/Hanover-Marketing-Rep-I-Job-MD-21075/2504228/250422825042282013-07-18AmerigroupSales & Marketingfull-timeUSDstarting0BSHanover, MD, US
Job ID 2013-22469 # Positions 1
Location US-MD-Hanover
Search Category Human Resources
Type Regular Full-Time (30+ hours) Posted Date 4/2/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for the development and delivery of initial and ongoing technical and professional skills training programs, with emphasis in the VA Medical Management department and in the Plans.

Responsibilities:

1. Principal liaison to Virginia Beach and Health Plan medical management departments.

2. Work closely with business partners.

3. Develop, implement and deliver training programs utilizing adult learning theories and principles.

4. Monitor key business indicators in order to identify training needs.

5. Utilize appropriate methods, techniques, and equipment.

6. Monitor effectiveness of programs and progress of trainees.

7. Support business operations.

8. Partner with plan associates to ensure training and development needs support key business objectives.

9. Provide feedback to business partners regarding challenge areas to improve productively and procedures.

10. Utilize superb platform skills to present technical information effectively in a classroom setting, one on one or using distance learning technology.

11. Other special projects and duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- College degree or equivalent experience.

Preferred:
- Bachelor’s or Master’s degree; training certification.

Years and Type of Experience Required:

Required:
- Managed Care Experience.
- 3-5 years training experience; technical training considered a plus. Training experience includes 1:1 training, SME experience, mentor, preceptor, classroom, etc. Does not need to be in an official training capacity.

Preferred:
- Case Management and/or Utilization Management experience or certification desirable.
- Training experience, preferably in health care.
- Technical background considered a plus.

Specific Technical Skills

Required:
- Working knowledge of Microsoft Office applications.

Certifications or Licensure

Required:
- LPN

Preferred:
- RN
- Training or managed care certification highly desirable.

Other:

Required:
- Capable of managing multiple, simultaneous projects.
- Demonstrated ability to succeed in a fast-paced, constantly changing environment.
- Appreciation of cultural diversity and sensitivity towards target population.
- Ability to become a subject matter expert in a variety of topics.
- Demonstrated ability to interface with employees and customers with a high degree of tact and diplomacy.
- Ability to meet company travel requirements.

Preferred:
- Healthcare information systems experience highly desirable.

Travel – Technical Trainers Up to 30%

Travel – Case Management / CarePlus Trainer May require up to 100%

PHYSICAL REQUIREMENTS
- Must be able to operate computer, phone and general office equipment.
- Must be able to travel as required using common carriers and adhere to AGP’s travel policies.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Hanover-Clinical-Trainer-Job-MD-21075/2525326/252532625253262013-07-18AmerigroupHuman Resourcesfull-timeUSDstarting0BSHanover, MD, US
Job ID 2013-22584 # Positions 1
Location US-MD-Hanover
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/15/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective care management, utilization of health, mental health, and substance abuse services.

Responsibilities:

1. Manages and oversees teams responsible for various HCMS functions including utilization management, case finding and coordinating those cases that involve co-morbid conditions and need to be part of the case management/disease management track.

2. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.

3. Works with providers to establish short and long term goals that meet the member’s need, functional abilities and referral sources requirements.

4. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.

5. Coordinates the identifications of members with potential for high risk complications; assesses members’ present level of physical/mental impairment utilizing defined criteria and methodology.

6. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.

7. Review benefit systems and cost benefit analysis.

8. Evaluates the member against level of care criteria.

9. Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma or Associate’s Degree in related Health/Nursing/Social Work field.

Preferred:
- Bachelor’s Degree in related Health/Nursing/Social Work field or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of five years experience in health Care Management and at least one year of leadership/management experience.

Certifications or Licensures

Required:
- RN, PA, LSW, MSW, LPC, LCSW LMHC, or LPN/LVN
- Behavioral Health may also have LMSP in addition to any of the above.

Preferred:
- Certified Case Manager or Certified Utilization Review Professional.

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
- Strong communication skills, both written and verbal; articulate, persuasive & Influential; systematic and timely.
- Demonstrate project management experience in organizing, planning and executing large-scale projects from conception through implementation.
- Experience in leading and developing people.

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: N/A

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.

CB1

ermHO
]]>http://www.amerigroup-jobs.com/job/Hanover-Manager%2C-Case-Management-Job-MD-21075/2546971/254697125469712013-07-18AmerigroupNursingfull-timeUSDstarting0BSHanover, MD, US
Job ID 2013-22849 # Positions 1
Location US-MD-Hanover
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/14/2013
Additional Locations ..

More information about this job:
Summary:

Key leadership role responsible for leading the development, implementation and coordination of a comprehensive health care program that will assist Health Care Management Services, Medical Management, and/or Utilization management, resulting in improved health outcomes for members.

Responsibilities:

1. Assists leadership peers in the 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 and Managers.

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

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

5. Provide contracting feedback recommendations based on identified network gaps and feedback from CMS associates.

6. Participates in complaint resolution and inquiries pertaining to HCMS programs.

7. Assists in developing clinical management guidelines, policies, and strategies.

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

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

10. Ensures program deliverables by monitoring established goals and implementing improvement strategies accordingly.

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

12. Ensures compliance with state reporting on healthcare management activities for accuracy.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:
- Bachelors Degree in related Health/Nursing field

Preferred:
- Master’s Degree in related Health/Nursing field or BSN with 5 years Behavioral Health and Managed Care experience.

Years and Type of Experience Required:

Required:
- Minimum of seven years clinical work experience, with at least three years of leadership/management experience.

Certifications or Licensures

Required:
- RN (preferred),LCSW, or LPC

Preferred:
- Certified Case Manager

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: 2-20

Budgetary $ Responsibility: As assigned

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.

CB1

ermHO
]]>http://www.amerigroup-jobs.com/job/Hanover-Director-Health-Care-Mgmt-Svcs-Behavioral-Health-RN-Job-MD-21075/2597175/259717525971752013-07-18AmerigroupNursingfull-timeUSDstarting0BSHanover, MD, US
Job ID 2013-22938 # Positions 1
Location US-MD-Hanover
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/22/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.
- Focus will be on inpatient adult/pediatric review

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

2. Predicts and plans for patient’s needs from pre-admission, through acute and sub acute 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. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

7. 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.

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

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of 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.

Certifications or Licensures

Required:
- RN
- Must possess a valid driver’s license and access to a motor vehicle.

Preferred:
- Certified Professional Healthcare Management

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Hanover-Utilization-Review-Nurse-Job-MD-21075/2611291/261129126112912013-07-18AmerigroupNursingfull-timeUSDstarting0BSHanover, MD, US
Job ID 2013-22924 # Positions 1
Location US-TN-Nashville
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/21/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

2. Predicts and plans for patient’s needs from pre-admission, through acute and sub acute 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. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

7. 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.

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

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of 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.

Certifications or Licensures

Required:
- LPN, LVN or LSW (depending on health plan needs or as mandated by state contract).
- Must possess a valid driver’s license and access to a motor vehicle.
- For Behavioral Health Dept/Specialty Requirements only: LMFT, LPC, LCSW.

Preferred:
- Certified Professional Healthcare Management.

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Nashville-Utilization-Manager-Job-TN-37201/2609154/260915426091542013-07-18AmerigroupNursingfull-timeUSDstarting0BSNashville, TN, US
Job ID 2013-21962 # Positions 1
Location US-TN-Nashville
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/29/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for conducting telephonic or face-to-face assessments for the identification, evaluation, coordination and management of Members’ needs, including physical health, behavioral health, social services and long term services and supports; develops the Member’s Individualized Service Plan to address those needs. Establishes relationships with referral sources and community resources, while maintaining strict member confidentiality and complying with all HIPAA requirements.

Responsibilities:

1. Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team

2. Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members’ health care needs while optimizing efficiency and quality outcomes.

3. Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member’s PCP or treating physician and specialists in the development of an Individual Service Plan.

4. Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.

5. Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member’s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.

6. Reviews benefit options, acquire data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.

7. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required: (as appropriate, based upon state contract licensure requirements).
- Nursing Diploma or Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role.

Preferred:
- Experience in home health, health care, discharge planning, behavioral health, collaborating with nursing facilities, community resources, and/or other home and community-based agencies.
- Experience working with Medicare, Medicaid, and managed care programs.

Certifications or Licensures

Required:
- Active licensed RN, LPN/LVN, LSW or LCSW, LMSW, as required by state contract.
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.

Language Skills

Required:
- English

Preferred:
- Bilingual (ability to read, write, and speak)

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with case or utilization management data systems.
- Solid understanding of the healthcare industry and government insurance programs.
- Seeks opportunities to acquire new knowledge and skills.
- Accepts feedback openly, without becoming defensive.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Follows up with customers to ensure problems are solved.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Nashville-Care-Coordinator-Davidson-in-house-Job-TN-37201/2629929/262992926299292013-07-18AmerigroupNursingfull-timeUSDstarting0BSNashville, TN, US
Job ID 2013-22976 # Positions 1
Location US-TN-Nashville
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/30/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Licensed RN Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

2. Predicts and plans for patient’s needs from pre-admission, through acute and sub acute 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. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

7. 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.

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

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of 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.

Certifications or Licensures

Required:
- RN
- Must possess a valid driver’s license and access to a motor vehicle.

Preferred:
- Certified Professional Healthcare Management

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Nashville-Utilization-Manager-RN-Maternal-Child-Health-Job-TN-37201/2629930/262993026299302013-07-18AmerigroupNursingfull-timeUSDstarting0BSNashville, TN, US
Job ID 2013-23025 # Positions 1
Location US-TN-Nashville
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 6/4/2013
Additional Locations ..

More information about this job:
Summary:

Manages and oversees team responsible for coordination of a comprehensive health care program in which members’ needs are identified, including physical health, behavioral health, social services and long term service and supports (LTSS)

Responsibilities:

1. Manages and evaluates team’s performance, including preparation of team and individual metrics, and ensures adherence to departmental standards.

2. Manages resource utilization to ensure appropriate delivery of care to members, adequate coverage for all tasks and job responsibilities; if applicable - monitors telephone queue to ensure adequate coverage while incorporating QA measures and providing appropriate feedback and counseling.

3. Provides guidance, feedback and training to team members facilitating the understanding of regulatory and compliance requirements.

4. Coordinates service delivery to include member assessment of physical and psychological factors.

5. Participates in various cross-functional workgroups created to maintain / develop program, including developing agenda items, conducting meetings, and publishing accurate minutes to record workgroup activities / decisions.

6. Evaluates current processes of all LTSS support functions; determines and recommends changes for increased efficiencies and improved outcomes.

7. May develop and conduct training programs for staff involved in LTSS programs.

8. May extracts and manipulates analytical data to present findings to relevant markets and stakeholders.

9. May establish relationships with advocacy groups.

10. May partner with Provider Relations to ensure LTSS provider satisfaction and resolution of issues.

11. Assists in the education and implementation of LTSS service delivery area expansion as needed.

12. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in related discipline.

Years and Type of Experience Required:

Required:
- Minimum of 5+ years’ relevant work experience and at least 1 year of leadership/management experience.
- Leadership Development Program in lieu of years of experience.

Preferred:
- Experience in a managed care setting with direct experience in service delivery coordination, discharge planning, or behavioral health.
- Experience working with LTSS population.
- Experience working in the community with community agencies.

Certifications or Licensures

Required:
- Valid Texas driver’s license and access to a motor vehicle (for TX market mgrs only).

Preferred:
- RN, LSW, LPN/LVN

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
- Analyze, incorporates and applies new information and concepts. Makes timely decisions on problems/issues requiring immediate attention.

SCOPE INFORMATION

# Direct Reports: 0-15

# Indirect Reports: 0

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/

ermHO
]]>http://www.amerigroup-jobs.com/job/Nashville-Mgr-LTSS-Plan-Job-TN-37201/2640305/264030526403052013-07-18AmerigroupNursingfull-timeUSDstarting0BSNashville, TN, USKeywords:
Call Center, Customer Service, CSR, Representative, Healthcare, Managed Care, Agent

Summary:

The Nashville Call Center, with operations in Nashville, TN, delivers a variety of support resources to members of Amerigroup's Health Plans.

Associates are focused on understanding and meeting the needs of our customers by connecting with the mission and vision in their daily work activity. While working with our customers over the phone, Customer Care associates use their analytical skills to identify issues and proactively engage to solve problems during the call. While anticipating the needs of our customers, Customer Care associates demonstrate good listening skills, strong verbal and written communication skills to help influence our customers resulting in an amazing customer experience.

If you are looking for a way to make a difference in the lives of others by offering a little help to those in need, you are invited to further explore employment opportunities at Amerigroup.

Responsible for responding to either inbound inquiries or outreach calls from/to potential and existing AMERIGROUP members and providers. Responsibilities include providing accurate information/education/resolution about eligibility status, benefit coverage, provider network, credentialing status, authorization/referral status, demographic changes and all other non-claim issues.

This position is located in Nashville, TN.
We are recruiting for training classes to start Summer 2013.

Responsibilities:
1. Function as an information source through telephonic assistance to members, providers, billing agencies, and various company/department staff.
2. Provide pleasant customer experience through superior customer service methods, problem solving and real-time issue resolution.
3. Interact with provider community and various departments to resolve issues involving the membership and credentialing status.
4. Explain benefits, eligibility status, enrollment processing procedures and status of authorizations and referrals to callers.
5. Assist with activities to ensure membership’s continuity of care.
6. Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls), complete health assessments for plan case management (Early Case Findings and Healthy Beginnings) and conduct membership surveys.
7. Process complaints, following established guidelines.
8. Maintain knowledge of state guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance.
9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education
Required:
• High school diploma or GED
Preferred:
• Some completed college courses or degree

Years and Type of Experience Required:
Required:
• Two years of experience in customer service or call center environment
Preferred:
• Managed care experience

Certifications or Licensures
Required:
• N/A

Language Skills
Required:
• English
Preferred:
• Other languages as determined by business need.

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment-Basic
• Ability to use software and hardware of a computer to complete certain simple tasks.
• Ability to use standard office equipment such as telephone, fax machine and copy machine.
• Working knowledge in a windows environment to include navigation skills using a mouse and keyboard and use of the Internet.
• Ability to review and draft correspondence in email system and word processing systems.
• Ability to use spreadsheets to review, organize and edit data.

Communication Skills: Verbal, Written and Call Handling-Basic
• Ability to use proper language, grammar and style in the preparation of verbal and written messages to convey a clear, concise, friendly and appropriate message to business partners and customers.
• Demonstrates skills to properly handle a telephone inquiry into the contact center. Properly greet the customer and provide information based on purpose for the call and script requirements.

Heath Care Industry Terminology
• Ability to understand basic health care industry terms, e.g. managed care, primary care physician, explanation of benefits, etc.

Read, Interpret and Apply Information
• Ability to read and comprehend the information and provide an explanation to the business partner or customer that is accurate and appropriate.
• Ability to research information using available resources.

Behavioral Competencies

Strategic Leadership
Be Strategic

• Demonstrates understanding of the organization's mission and strategies.
• Works to clarify and understand the broader purpose and mission of own work.
• Integrates and balances big-picture concerns with day-to-day activities.
• Generates innovative ideas and solutions to problems.
• Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions

• Approaches problems with curiosity and open-mindedness.
• Collects sufficient information to understand problems and issues.
• Analyzes problems and issues from different points of view.
• Applies accurate logic and common sense in making decisions

People Leadership
Develop/Support Organizational Talent

• Relates to people in an open, friendly, and accepting manner.
• Treats others with respect.
• Listens carefully and attentively to others’ opinions and ideas.
• Maintains positive relationships even under difficult or heated circumstances.
• Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration

• Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
• Appropriately involves others in decisions and plans that affect them.
• Provides honest, helpful feedback to others on their performance.
• Shares own experience and expertise with others.

Results Leadership
Show Drive and Initiative

• Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
• Maintains a consistent, high level of productivity.
• Takes personal responsibility to make decisions and take action.
• Does not easily give up in the face of unexpected obstacles.
• Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution

• Juggles many priorities and competing demands for one's time.
• Acts resourcefully to ensure that work is completed within specified time and quality parameters.
• Removes obstacles in order to move the work forward and/or get efforts back on track.
• Surfaces problems and issues before projects get derailed.

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 travel as needed and adhere to Amerigroup travel policies and procedures.CB1
]]>http://www.amerigroup-jobs.com/job/Nashville-Customer-Care-Representative-TN-37201/2375282/237528223752822013-07-18Amerigroup4300101full-timeUSDstarting0BSNashville, TN, US
Job ID 2013-22925 # Positions 1
Location US-IN-Indianapolis
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/28/2013
Additional Locations ..

More information about this job:
Summary:

This position is responsible, for developing, coordinating, communicating and implementing a strategic clinical quality management and improvement program within their assigned health plan. This 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. Represent organizational interests by serving as a liaison for clinical quality initiatives with state/federal regulatory agencies, and collaborates with regulatory, compliance, and government relations leaders to meet external quality information needs. Provides operational leadership and quality-related business strategy for all aspects of the QM program within the Plan. Collaborates with enterprise-wide quality leaders to ensure appropriate communication, integration and utilization of best practices in all areas.

Responsibilities:

1. Promotes broad understanding, communication, and collaboration with enterprise-wide quality leaders to ensure appropriate communication, integration and utilization of best practices in all areas.

2. Oversees internal and state QM Scorecard reporting including analyzing validity of Clinical Quality management data/reports from a clinical perspective.

3. May provide oversight for the member complaint, appeal processes, privacy compliance processes, or auditing of delegated services in assigned area.

4. Demonstrates leadership for the member/provider satisfaction survey process, inclusive of root cause analysis and multifunctional action plans for improvement.

5. Provides oversight for Health Employer Data Information Sets (HEDIS) reporting and provides leadership to the development and realization of action plans to achieve target improvement goals.

6. Supports the health plans’ External Quality Review Organization (EQRO) reporting and state audit processes.

7. Provides leadership for QM representation in new business activities (RFP responses, new market/product development, and state contract changes etc.)

8. Provides leadership to ensure compliance with National Committee for Quality Assurance (NCQA) standards, or other accrediting bodies such as URAC and AAAHC.

9. Ensures an effective process for reporting information to support provider recrednetialing, medical record reviews, and other performance and quality of care indicators.

10. Develops and manages annual operating and capital budget to sufficiently meet departmental needs and ensure the best utilization of resources.

11. Selects, manages, and develops new and existing departmental staff and ensures a healthy working environment.

12. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in health or business related field.

Preferred:
- Advanced degree in health or business related field.

Years and Type of Experience Required:

Required:
- 10 years of Experience in a healthcare environment which includes significant leadership roles and previous accountability for broad CQM initiatives.
- Demonstrated expertise in driving positive, strategic results related to NCQA, HEDIS, or Clinical Quality Performance Measurement and Improvement Programs.
- Strong qualitative and quantitative data analysis skills and experience.
- 6 years of leadership/management of others to include team leadership and supervision of management level roles.
- Any combination of education & experience which provides an equivalent background may be considered.

Preferred:
- CQM experience in a Managed Care Organization strongly preferred.
- Population health management and/or clinical quality program development experience strongly preferred.
- New market expansion experience.

ADDITIONAL POPULATION/MARKET SPECIFIC EXPERIENCE REQUIREMENTS MAY APPLY.

Certifications or Licensures

Required:
- N/A

Preferred:
- Current clinical license strongly preferred. Candidates without may only be considered where direct or 1-over reporting relationship to a clinician is feasible.

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

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.

Job Title: VP Quality Management

Job Grade: 23

Salary Range: $101,925 - $135,900 - $169,875

MJO:20%

LTI:15k

ermHO
]]>http://www.amerigroup-jobs.com/job/Indianapolis-VP-Quality-Management-Plan-Job-IN-46201/2611284/261128426112842013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSIndianapolis, IN, US
Job ID 2013-22926 # Positions 1
Location US-IN-Indianapolis
Search Category Health Care Administration
Type Regular Full-Time (30+ hours) Posted Date 5/22/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for the development, implementation and oversight of integrated Medical Management primarily in the Health Plan. These initiatives will include the establishment of indicators for monitoring and evaluating quality care, appropriateness, continuous improvement, member satisfaction, utilization, and case management across the continuum of care to members. Provides education in the area of healthcare management. Serves as liaison to state regulatory agencies. Participates in accreditation of plan with the National Committee of Quality assurance. Develops professional relationships with community agencies.

Responsibilities:

1. Directs and provides leadership for designing, developing, and implementing the local Plan integrated medical management program to meet the demographic and epidemiological needs of the population serviced.

2. Directs Healthcare Management Program for membership including disease management, case management, and utilization management.

3. Establishes objectives and annual goals in conjunction with the Medical Director to meet objectives established by the Plan CEO/COO and corporate HCMS.

4. Promotes understanding, communication, and coordination of Integrated Medical Management Programs across the health plan.

5. Works with Provider Relations, Quality Management and Health Promotions to develop and implement effective provider communications, quality assurance and member outreach programs.

6. Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.

7. Coordinates on a quarterly basis reporting of quality initiatives to all appropriate plan committees.

8. Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.

9. Monitors and makes recommendations for oversight of appropriate delegated services.

10. Develops the annual operating and capital budget: ensures that departments stay within budget and accounts for variances.

11. Works collaboratively with key health care professionals toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problems resolution.

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors Degree in a health care field or equivalent experience (equivalent experience equates to 6 years related experience in addition to the required 12 years experience).

Preferred:
- Masters Degree in a health care field, or
- MBA with Health Care concentration.

Years and Type of Experience Required:

Required:
- Minimum of 12 years relevant clinical work experience and at least 7 years of leadership/management experience preferably in a managed care setting , with at least 5 years of clinical experience (post Masters for Behavioral Health).
- Previous experience with NCQA accreditation and HEDIS reporting.

Certifications or Licensures

Required:
- RN, LCSW, LPC

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

SCOPE INFORMATION

# Direct Reports: 5-30

# Indirect Reports: varies

Budgetary $ Responsibility: As assigned

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.

Job Title: VP HCMS

Job Grade: 23

Salary Range: $101,925 - $135,900 - $169,875

MJO:20%

LTI:15k

ermHO
]]>http://www.amerigroup-jobs.com/job/Indianapolis-VP-Healthcare-Mgmt-Svcs-Job-IN-46201/2611285/261128526112852013-07-18AmerigroupHealth Care Administrationfull-timeUSDstarting0BSIndianapolis, IN, US
Job ID 2013-22933 # Positions 1
Location US-IN-Indianapolis
Search Category Finance
Type Regular Full-Time (30+ hours) Posted Date 5/22/2013
Additional Locations ..

More information about this job:
Summary:

The Director Finance – Plan is responsible for managing the budgeting, forecasting, and financial analysis functions of the health plan to ensure the achievement of membership, premium, medical expense, gross margin, and local SG&A goals on a quarterly and annual basis. Either directly or by managing a team of Performance Managers develop, coordinate and monitor the annual budget, quarterly forecasts, financial statement analysis and interpretation, Work collaboratively with health plan and corporate management in all areas of responsibility to ensure the organization is focused on current results vs. budget, current financial performance trends, and the identification and execution of initiatives to properly manage revenue, medical, gross margin, and SG&A to plan. Provide analytical support to all areas of the Health Plan Operations.

Responsibilities:

Either through direct action or through the Management/Supervision of a team of Performance Managers collectively perform the following:

1. Perform all management functions including supervision, hiring, firing and training of staff.

2. Conduct all personnel reviews, assessments per Associated Services policies.

3. Directly or through the performance of the team define, coordinated topline, medical expense, and local/direct SG&A portions of annual budget process & quarterly forecasts:

a. Drive process with Plan leadership in conjunction with COO coordinate all analysis required for membership, premium yield, medical expense, and local/direct admin by product;

b. Provide all required files to Home Office departments within required timeframes.

4. Provide updated topline and medical projections as needed by the Home Office due to material changes in the business environment (new membership, new product, new provider contract, etc.)

5. On a monthly and quarterly basis, provide necessary information to Actuarial for the medical accruals including:

a. Large cases not in claim experience;

b. Major contract changes not in claim experience;

c. Other utilization or unit cost events not in claim experience.

6. Full participation in monthly operational meetings, financial statement meetings, and medical accrual meetings.

7. On a quarterly basis, provide all necessary information for the other known liabilities, including detailed analysis for auditor review, within required timelines of close process.

8. On a monthly basis, analyze, interpret, and communicate financial statement and medical accrual results to plan leadership for the month, quarter-to-date, and year-to-date:

a. Identify and explain all variances to budget/forecast;

b. Identify trends & key drivers in revenue and medical and roll them into ACT process for action;

c. Assess impact on quarterly and full year budget/forecast targets for topline, medical expenses, gross margin, HBR, and pre-tax/pre-corporate earnings

9. Conduct and manage all required analysis for the ACT program:

a. Identify, assess, document, and monitor all opportunities to maximize revenue and manage medical expenses to budget/forecast through membership, premium rate, unit cost, utilization, and cost containment initiatives;

b. Ensure 150% of gross margin gap to budget/forecast is explained at all times;

c. Fully utilize process tools and methodologies in accordance with Corporate standards.

10. Fully engage with other Plans and Home Office departments to identify, define, and use standard tools and analytical approaches, including use of common data sets. Interaction with Medical Finance, Finance, Medical Management, Claims, Cost Containment, Provider Service Operations, and Premium Reconciliation is expected.

11. Participate and contribute to “Best Practice” forums with other Plans and Home Office to share initiative successes, share lessoned learned, identify best practices across the company, and identify new initiatives not currently implemented at the Plan.

12. Monitor monthly cost containment activity, including investigation and resolution of adverse changes in collection activity a. Provide direction to Cost Containment Unit for additional expense savings opportunities not taken.

13. Monitor monthly claims production, including investigation and resolution of adverse changes in production statistics and their impact on medical accrual estimates.

14. Monitor monthly supplemental revenue collections such as Maternity kick payments, Newborn kick payment, and reimbursable drugs, including investigation and resolution of adverse changes in collection activity.

15. Monitor, analyze, and report any variances for local and direct administration expenses.

16. Identify and drive opportunities for savings with Plan leadership on a monthly basis.

17. Prepare the analysis to work with Actuarial to understand key drivers of the premium development for each product.

18. Identify and monitor the assumptions and issues in the rate methodology that drive financial success including trend, populations covered, benefits covered, unit cost assumptions, risk adjustment, birth rates, newborn enrollment rules, special populations (i.e. AIDS/HIV), utilization assumptions, and program changes:

a. Communicate to key Plan leadership and ensure they understand the drivers of success underneath the premium rates;

b. Monitor performance against quantifiable drivers of premium rates and resolve adverse variances as they arise.

19. Develop and enhance data collection and analytical tools to support the plan.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- BA or BS in Accounting, Finance, or Actuarial Science.

Preferred:
- MBA in Accounting, Finance, or Actuarial Science.

Years and Type of Experience Required:

Required:
- 7 years of Finance, Accounting, or Actuarial experience including budgeting, financial statement analysis, provider contract analysis, utilization analysis, and basic underwriting, and 3 years leadership or management experience.

Specific Technical Skills

Required:
- Proficient in Microsoft Windows environment including the Office suite of products, proficiency with database programs such as Microsoft Access, advanced skills in Microsoft Excel, advanced analytical skills, and excellent communication skills.

Preferred:
- Hyperion Pillar, SPSS or equivalent, SQL.

Other:

Required:
- Strong communication skills, both written and oral – ability to present information effectively to corporate management, plan management and providers.
- Ability to manage a professional staff of analysts
- Ability to interface effectively with both technical and business owners.
- Ability to function effectively with a minimum of direction, relying on internal motivation and personal experience to analyze problems and seek out solutions.
- Excellent analytical skills and attention to detail.
- Excellent organizational skills; the ability to handle multiple priorities simultaneously with a high quality result.
- Appreciation of cultural diversity towards target population.

SCOPE INFORMATION

# Direct Reports:

# Indirect Reports:

Budgetary $ Responsibility: Entire Plan budget.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.
- Travel required and must be able to travel on common carriers and to adhere to AMERIGROUP’s travel policies.
- Standing and sitting for long periods of time.
- Data Entry using repetitive motions of fingers and forearms.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Indianapolis-Director-Finance-Plan-Job-IN-46201/2611289/261128926112892013-07-18AmerigroupFinancefull-timeUSDstarting0BSIndianapolis, IN, US
Job ID 2013-22870 # Positions 1
Location US-CA-Fresno
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/16/2013
Additional Locations ..

More information about this job:
Summary:

Key leadership role responsible for leading the development, implementation and coordination of a comprehensive health care program that will assist Health Care Management Services, Medical Management, and/or Utilization management, resulting in improved health outcomes for members.

Responsibilities:

1. Assists leadership peers in the 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 and Managers.

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

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

5. Provide contracting feedback recommendations based on identified network gaps and feedback from CMS associates.

6. Participates in complaint resolution and inquiries pertaining to HCMS programs.

7. Assists in developing clinical management guidelines, policies, and strategies.

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

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

10. Ensures program deliverables by monitoring established goals and implementing improvement strategies accordingly.

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

12. Ensures compliance with state reporting on healthcare management activities for accuracy.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:
- Bachelors Degree in related Health/Nursing field

Preferred:
- Master’s Degree in related Health/Nursing field

Years and Type of Experience Required:

Required:
- Minimum of seven years clinical work experience, with at least three years of leadership/management experience.

Certifications or Licensures

Required:
- RN,LCSW, or LPC

Preferred:
- Certified Case Manager

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: 2-20

Budgetary $ Responsibility: As assigned

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Fresno-Director-Health-Care-Mgmt-Svcs-Job-CA-93650/2602077/260207726020772013-07-18AmerigroupNursingfull-timeUSDstarting0BSFresno, CA, US
Job ID 2013-22996 # Positions 1
Location US-CA-Fresno
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/31/2013
Additional Locations ..

More information about this job:
Summary:

The Manager of Quality Management is responsible in conjunction with the plan leadership for developing, coordinating, and implementing quality initiatives within the health plan. Provides process and technical supervision to a team responsible for monitoring and evaluating the quality of care/service, appropriateness, continuous improvement, member satisfaction, and results of actions across the continuum of care to members. Assist in coordinating the quality management program activities throughout the functional areas of the health plan.

Responsibilities:

1. Assists in establishing objectives and annual goals in conjunction with the plan leadership.

2. In conjunction with the plan QM leader, implements the comprehensive Quality Management Program to meet the demographic and epidemiological needs of the population served.

3. Promotes plan-wide understanding, communication, and coordination of the quality management program.

4. Manages and evaluates team’s performance and ensure adherence to department’s standards.

5. Trends quality data and develops aggregate and individual plan reports as indicated. Analyzes validity of data/reports.

6. Coordinates on a quarterly basis reporting of all quality/risk initiatives to all appropriate committees.

7. Develops, designs, implements and evaluates activities including coordination of focus studies and other indicators of quality of care/service.

8. Coordinates development, implementation, and evaluation of continuous quality improvement action plans for the improvement activities.

9. Participates in the reporting of Plan data and coordinates the improvement action plans.

10. Coordinates the state regulatory quality reporting for the health plan.

11. Provides support for provider recredentialing in the areas of medical record reviews, quality indicators and trended data.

12. Assures compliance with State and Federal quality improvement requirements. Prepares plan staff for successful State and internal audits.

13. Maintains liaison for quality initiatives with State and Federal regulatory agencies as needed.

14. Evaluates and makes recommendations for oversight of delegated services.

15. Assists in developing the annual operating and capital budgets to sufficiently meet departmental needs and ensures that department stays within budget and accounts for variances.

16. Interviews, manages, evaluates, and develops new and existing departmental staff.

17. Recognizes and utilizes appropriate channels for communication and encourages two-way communication and encourages staff to participate in creative program development.

18. Work collaboratively with key health care professionals toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problem resolution.

19. Effectively communicates information to superiors, team members, and other appropriate staff in a timely, accurate, and courteous manner.

20. Actively participates in meetings and helps maintain an effective work group.

21. Develops presentations on activities for a variety of audiences as needed.

22. Plan and execute an annual member and provider outreach plan.

23. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associates Degree or equivalent work experience.

Preferred:
- Bachelors Degree, or MSN, MPH, MPA.

Years and Type of Experience Required:

Required:
- Minimum of 5 years of current experience in quality improvement, and/or utilization review in HMO setting with at least 1 year management/leadership experience.

Preferred:
- Previous NCQA accreditation and HEDIS reporting experience.
- Experience with the urban Medicaid population.

Certifications or Licensure

Required:
- N/A

Preferred:
- Current state RN license preferred, Risk Management License preferred; CPHQ preferred.

Other:

Required:
- Strong knowledge base in areas of quality improvement.
- Excellent written and verbal communication skills.
- Ability to work effectively with physicians and other health care providers as well as with multi-disciplinary teams across department lines.
- Excellent problem solving skills.
- Demonstrates strong organizational skills.
- Knowledge of basic computers including word processing and spreadsheets.
- Ability to work in a team environment.
- Ability to develop and give presentations.
- Ability to handle multiple tasks.
- 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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Fresno-Manager%2C-Quality-Management-Job-CA-93650/2633193/263319326331932013-07-18AmerigroupNursingfull-timeUSDstarting0BSFresno, CA, US
Job ID 2012-21362 # Positions 1
Location US-VA
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 12/3/2012
Additional Locations ..

More information about this job:
Summary:

The Quality Management (QM) Business Consultant is responsible for improving Amerigroup’s value to our customers by supporting continuous quality improvement in healthcare services delivered to its members, as well as for improving Amerigroups performance on all clinical outcome related measures. This responsibility extends to the Medicaid and Medicare lines of business.

Responsibilities:

1. Will serve as a facilitator/champion for two or more clinical quality management department sponsored workgroups and committees. This will include one or more quality domain workgroups and Plan/Corporate HEDIS workgroups. The incumbent’s role is to facilitate and organize business process development/improvement from launch through implementation as well as ongoing evaluation and revision.

2. Will be responsible to develop and implement clinical quality initiatives that will ensure Amerigroup meets or exceeds accreditation and regulatory requirements as determined by NCQA, CMS, state DOH and DOI entities as well as compliance with health care reform.

3. Will be responsible for the retrieval and analysis of various types of data sets as well as searching current literature in an effort to identify potential barriers to members receiving necessary preventive services. Data sets will include but not be limited to HEDIS, state specific HEDIS-like information, CMS Stars information and measures related to Amerigroups Long Term Care product, those required for healthcare reform and those related to Amerigroup clinical quality initiatives, such as patient safety.

4. Responsible for keeping abreast of internal and external activities not directed by CCQM that impact HEDIS strategy and outcomes and to appropriately collaborate and factor this information into the development of clinical quality initiatives.

5. Will require the ability to synthesize analysis and information from data and provide clinical expertise and recommendations for member and provider interventions towards improvement.

6. Upon direction from the AVP Performance Outcomes, will serve on corporate and plan teams focused on outcomes management; for example, the corporate health promotions workgroup, ad hoc teams to support outcomes information for RFP’s and RFI’s, etc.

7. Will be responsible for defining and creating best practices among health plans and through research, communicating information enterprise wide and creating standardized tools, templates and training materials.

8. Works closely with corporate and health plan HEDIS, accreditation and clinical guideline staff.

9. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associate’s degree in Nursing.

Preferred:
- Bachelor’s degree in Nursing, business or health care management.

Years and Type of Experience Required:

Required:
- 3 years experience as a Registered Nurse.
- 3-5 years experience in healthcare/health plan operations using quality improvement tools, process analysis.

Preferred:
- 1-2 years experience in managed care quality management environment.

Specific Technical Skills

Required:
- 3 years experience in managing projects and use of MS Office products.

Preferred:
- 1-2yrs experience with HEDIS and/or clinical outcome measures.

Certifications or Licensures

Required:
- RN Licensure.

Other:

Required:
- Excellent verbal and written communication skills.
- Ability to evaluate quality data to make comparisons, develop goals, recommendations and action plans based on results.
- Ability to facilitate and lead cross functional/multi-departmental teams related to clinical quality improvement.

Preferred:
- Effective planning and implementation skills.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Business-Consultant-RN%2C-Quality-Management-Job-VA/2304822/230482223048222013-07-18AmerigroupNursingfull-timeUSDstarting0BS, ,
Job ID 2013-21631 # Positions 1
Location US-NATIONWIDE
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 1/9/2013
Additional Locations ..

More information about this job:
Summary:

In accordance with the Project Management Body of Knowledge (PMBOK) and PMI standards, independently leads multiple projects or one larger project. Responsible for all aspect of the project. Responsible for familiarity with system scope and project objectives, as well as the role and function of each project team member or functional area, to effectively manage the activities of the team. Responsible for assembling project team, assigning individual responsibilities, identifying appropriate resources needed, and developing schedule to ensure timely completion of project.

Responsibilities:

1. Execute the tasks as defined in the project plan in order to achieve the project goals.

2. Manage changes to the project scope, project schedule, and project costs using appropriate verification techniques in order to keep the project plan accurate, updated, reflective of authorized project changes as defined in the change management plan, and facilitate customer acceptance.

3. Assists senior Project Managers and business leaders to ensure resource availability, workload and performance as well as to drive project vision through effective risk management and manage changes through a defined change management system.

Assist in the mentoring of junior project managers, coordinators and business analysts.

4. Measure project performance using appropriate tools and techniques in order to monitor the progress of the project, identify and quantify any variances, perform any required corrective actions, and communicate to all stakeholders.

5. Communicate to ensure a common understanding by setting expectations in accordance with the Project Plan, in order to align the stakeholders and team members.

6. Record detailed customer requirements, constraints, and assumptions with stakeholders in order to establish the project deliverables, using requirement-gathering techniques and the project charter.

7. Conduct a kick-off meeting with all key stakeholders in order to announce the start of the project and review the overall project plan and gain consensus.

8. Implement the approved actions and workarounds required to mitigate project risk events in order to minimize the impact of the risks on the project.

9. Improve team performance by building team cohesiveness, leading, mentoring, training, and motivating in order to facilitate cooperation, ensure project efficiency.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree or equivalent experience.

Years and Type of Experience Required:

Required:
- 3 - 5 years Project Management/Project Coordination Experience.

Preferred:
- Health care insurance industry experience.
- MS Project, Outlook, PowerPoint and Visio experience.
- Familiarity with data collection and analysis techniques.
- Survey tools experience, e.g. Survey Monkey.

Certifications or Licensures

Required:
- Strongly preferred PMI CAPM (Certified Associate in Project Management) or ability to obtain within first six months.

Preferred:
- PMI PMP (Project Management Professional)

Language Skills

Required:
- English

TECHNICAL COMPETENCIES

Project Management - Intermediate
- Ability to independently lead small to medium projects or one large project in accordance with Project Management Body of Knowledge (PMBOK) and Project Management Institute (PMI) standards. Solid understanding of process improvement and project management including tools and techniques, critical path method, program evaluation and review technique, resource balancing and cost estimating. Ability to clarify and interpret the relationships between a system and its component parts.

Industry Knowledge & Familiarity - Intermediate
- Solid understanding of the healthcare industry and government insurance programs, e.g. Medicare, Medicaid, CHIP and LTC.

Computer Skills and Office Equipment - Intermediate
- Ability to use software and hardware of a computer, e.g. Outlook, PowerPoint, etc., to complete certain moderately complex tasks. Able to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key. Use of internet, familiarity with SharePoint sites. Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to solve problems. Ability to create and manipulate spreadsheets (i.e., data entry and format cells).

SCOPE INFORMATION

# Direct Reports: 0

Project Budget Range: $0 - $1 million

Project Team Size: 6-10

Project Duration: 1 – 11 months

Project Timeline: Moderately Aggressive

Project Risk: Medium

# of System Interfaces: Multiple

#of Geographical Regions: 2

# of Functional Disciplines/Stakeholders: 1-5

# of Sub-Projects: Multiple

Level of Innovation / Means to Achieve Goals: Primarily Existing / Minor Modifications

Project Scope Definition: Fairly Defined

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Project-Manager-II-%28Health-Care-Economics%29-Job-VA-23450/2368498/236849823684982013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BS, ,
Job ID 2013-21760 # Positions 1
Location US-NATIONWIDE
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 1/17/2013
Additional Locations ..

More information about this job:
Summary:

Independently designs, develops, modifies, debugs and evaluates programs for functional and operational areas. Receives technical guidance only on unusual or complex problems or issues. 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.

Responsibilities:

1. Develops program logic for new applications or analyzes and modifies logic in existing applications. Identifies and creatively resolves complex problems.

2. Modifies moderate to complex application programs from detail specifications.

3. Applies a comprehensive knowledge and works independently to code, test, debug, document, implement and maintain software applications.

4. Creates a complex design document through the assessment of requirements. Assesses alternatives to different designs and selects best solution to fit business needs.

5. 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.

6. Assists in ensuring that system improvements are successfully implemented. Resolves complex design issues utilizing software development lifecycle and development methods.

7. Develops multiple, modular objects and the messaging interface between objects to create a complex software package. Reuses objects and creates object inventories.

8. Performs complex queries and updates of tables. Performs complex data modeling and database design with minimal oversight.

9. Defines requirements for application infrastructure including scalability, reliability, availability and serviceability and the trade-offs of each.

10. 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.

11. Performs moderate to complex application administration and support.

12. Performs other duties as assigned/requested.

Qualifications:

EDUCATION REQUIRED

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:
- Five years relevant work experience.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Advanced
- Thorough understanding of the core IT applications and systems and the inter-relationship among them. Advanced proficiency with all applicable company supported software applications and the associated infrastructure.
- Ability to use hardware and software of a computer to complete certain complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Proficiency in a windows environment to include navigation skills and use of internet. Ability to review and draft correspondence in email and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Programming Analysis - Advanced
- Thorough understanding of data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Understanding of referential integrity, locking and transaction processing. Understands impact of data modeling decision on system performance and resource usage. Knowledge of current and evolving application architecture trends to include infrastructure, software, database, networks and their interdependencies. Thorough understanding of Object oriented analysis and design. Thorough understanding of programming languages such as Objective C, Java, etc. Thorough understanding of environments used when programming such as .NET container or J2EE application server. Understands the strategic alignment of IT solutions with business objectives.

Project Management - Advanced
- Ability to develop and implement moderately complex project plans, and manage a project with supervision.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Programmer-Analyst-III-Job-VA-23450/2382783/238278323827832013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BS, ,
Job ID 2013-21988 # Positions 1
Location US-NATIONWIDE
Search Category Actuarial Services
Type Regular Full-Time (30+ hours) Posted Date 2/8/2013
Additional Locations ..

More information about this job:
Summary:

The Actuarial Analyst III examines, and summarizes statistical data by applying mathematical and statistical knowledge in areas such as medical claim accruals, trend analysis, experience analysis, forecasting, market and product premium rate process, and other duties as directed or assigned. Incumbent has acquired an advanced understanding of actuarial concepts, reporting, and insurance knowledge and is capable of recommending improvements and assumptions to be used.

Responsibilities:

PRIMARY RESPONSIBILITIES are drawn from the following:

1. Monthly and Quarterly Medical Accruals.
- Determines current month medical accruals for assigned markets with minimal supervision.
- Coordinates with responsible parties in Med Finance, Finance, or Plans to provide necessary information and research moderately complex questions.
- Actively participates in various monthly accrual meetings, and may conduct meetings, with limited supervision.

2. Market Specific Premium Rate Process.
- Maintains and incorporates programming changes to projection models to determine future healthcare costs by market.
- Actively participates in lower level meetings to develop assumptions.
- Analyzes financial impact of state’s pricing assumptions with some direction.

3. Internal Trend and Experience Analysis.
- Develops rate and trend experience by market and identifies statistics requiring analysis.
- Performs moderately complex actuarial analyses and projections to address business issues with some direction. - Participates in the budget/proforma process including analysis and projections for medical expenses and premium.
- Prepares medical expense components, and leads process for state experience report submissions. Identifies potential problems with submissions and recommends solutions.

4. Actuarial Models and Databases.
- Maintains and performs analysis of moderate complexity for certain tables within the corporate decision support tool.

5. May provide technical guidance to less experienced professionals and technicians.

6. May indirectly supervise less experienced professionals and technicians.

7. Performs other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in mathematics, business, finance, or related area.

Years and Type of Experience Required:

Required:
- Minimum of three years actuarial experience with two years experience in healthcare.
- Understanding of actuarial concepts, reporting, and insurance knowledge.
- Proficient analytical skills.

Preferred:
- Minimum of four years actuarial experience in healthcare.

Specific Technical Skills

Required:
- Knowledge of Microsoft Excel and Microsoft Access or other relational database applications.
- Proficient with Windows-based environment including Microsoft Office products not identified above.

Preferred:
- Advanced knowledge of Information Systems including database design and query tools such as SQL, SAS, or SPSS.

Certifications or Licensures

Required:
- Successful completion of four Society of Actuaries exams.

Preferred:
- Continued study toward ASA.

Other:

Required:
- Proven organizational skills.
- Excellent communication skills.
- Able to provide professional and appropriate written and verbal information.

BEHAVIORAL COMPETENCIES

Strategic Leadership

Be Strategic
- Develops responses to key competitor actions and threats.
- Identifies and integrates organizational strategies to achieve and sustain competitive advantage.
- Develops strategies that position the business to shape and capitalize on emerging customer and market needs. - Develops strategies that leverage the core capabilities and competencies of the company.

Make Sound Decisions
- Recognizes the broad, systemic implications of problems and issues.
- Focuses on the crux of issues, and identifies high-leverage intervention points and strategies.
- Critically and logically evaluates the costs, risks, and benefits of alternatives before making decisions.
- Makes decisions in the face of uncertainty.

People Leadership Develop / Support Organizational Talent
- Shapes roles and assignments in ways that leverage and develop people's capabilities.
- Develops successors and talent pools to ensure availability of future talent.
- Provides feedback, coaching, and guidance where appropriate to enhance others' skill development.
- Identifies and attracts key individuals with the critical capabilities needed by the organization.

Ensure Collaboration
- Builds collaboration by establishing, communicating, and reinforcing shared values and norms.
- Promotes a culture of collaboration and teamwork across organizational boundaries.
- Removes organizational barriers to collaboration and teamwork.
- Creates an environment for honest and open discussion of all issues, even controversial ones.

Results Leadership Show Drive and Initiative
- Establishes aggressive goals for the organization.
- Gets results that have a clear, positive, and direct impact on business performance.
- Conveys a strong sense of urgency and drives issues to closure.
- Manages focused, results-oriented meetings that achieve closure on key issues.

Accountability/Optimize Execution
- Uses key indicators, processes, and management systems to monitor the organization's performance against goals.
- Addresses barriers to achieving results and sources of lagging performance.
- Ensures accountability for achieving business goals at multiple organizational levels.
- Maintains operating effectiveness while simultaneously driving needed change.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 0-2

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 as needed and adhere to Amerigroup travel policies and procedures.

CB1

ermCorp
]]>http://www.amerigroup-jobs.com/job/Actuarial-Analyst-III-%28Atlanta-or-Virginia-Beach%29-Job/2420537/242053724205372013-07-18AmerigroupActuarial Servicesfull-timeUSDstarting0BS, ,
Job ID 2013-22006 # Positions 1
Location US-NATIONWIDE
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 2/12/2013
Additional Locations ..

More information about this job:
Summary:

Operating with considerable latitude, 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.

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 applying mastery of existing and emerging technologies and practices.

2. Independently modifies complex application programs from specifications. Provides technical consulting on complex projects.

3. Recommends changes in development, maintenance and system standards.

4. Uses extensive knowledge to independently codes, tests, debugs, documents, implements and maintains software applications.

5. Creates a highly complex design document through the assessment of requirements. Assesses alternatives to different designs and selects best solution to fit business needs.

6. 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.

7. Ensures that system improvements are successfully implemented. Resolves highly complex design issues utilizing software development lifecycle and development methods.

8. 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.

9. Develops multiple, modular objects and the messaging interface between objects to create a highly complex software package. Reuses objects and creates object inventories.

10. Creates and guides definition of good database design practices. Designs highly complex data models and databases with minimal assistance.

11. 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.

12. Performs complex application administration and support.

13. Serves as subject matter expert providing assistance and training to less experience team members.

14. Performs other duties as assigned or requested.

Qualifications:

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.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Expert
- Comprehensive understanding of the core IT applications and systems, and the inter-relationship among them. Complete proficiency with all applicable company supported software applications. Moderate to comprehensive understanding of supported applications and all interdependencies (OS, network, server, workstations, etc.).
- Ability to use hardware and software of a computer to complete certain complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Proficiency in a windows environment to include navigation skills and use of internet. Ability to review and draft correspondence in email and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Programming Analysis - Expert
- Extremely high level of understanding of all data modeling concepts and practices, database design, database performance and optimization. Extremely competent in handling software development issues related to databases for relational, object-oriented, and other database and software technologies.
- Thorough understanding of data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Understanding of referential integrity, locking and transaction processing. Understands impact of data modeling decision on system performance and resource usage. Knowledge of current and evolving application architecture trends to include infrastructure, software, database, networks and their interdependencies.
- Understands the strategic alignment of IT solutions with business objectives. Able to design and implement coding standards and best practices for a client server development language. Able to design and develop complex packages in an object oriented language. Extensive understanding of Object oriented analysis and design.
- Extensive understanding of programming languages such as Objective C, Java, etc. Extensive understanding of environments used when programming such as .NET container or J2EE application server.

Project Management - Expert
- Ability to develop and implement large and/or complex project plans, and manage one or more projects.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

SCOPE INFORMATION

# Direct Reports:

# Indirect Reports:

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.

D: JR

ermIT
]]>http://www.amerigroup-jobs.com/job/ITS-Programmer-Analyst-Principal-Data-WarehouseHedis-%28Telecommuters-Accepted%29-Job/2425667/242566724256672013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BS, ,
Job ID 2013-22818 # Positions 1
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 6/6/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for auditing and facilitating the recovery of claims overpayments as identified by our business partners. This person is responsible for research, analysis, documentation, outreach to providers, coordination of resolutions to overpayment issues, and recovery of identified overpayments.

Responsibilities:

1. Audits paid claims for overpayments using various techniques including systems-based queries, specialized reporting or other research.

2. Performs collection activities to ensure the recovery of overpayments and negative balance accounts.

3. Works closely with contract managers to identify and correct contractual issues, when applicable.

4. Conducts complex case research and resolution for projects involving overpayments.

5. Interprets provider contracts as they relate to overpayment opportunities in compliance with Amerigroup, federal and state rules and regulations.

6. Ensures high customer satisfaction when acting as a liaison between department, health plans and high profile providers to resolve overpayment recoveries.

7. Assists in reviews of state complaints related to overpayments or negative balances.

8. Facilitates the resolution of state complaints within strict timelines established by the state.

9. Creates and interprets requirements and recommends methods to reduce overpayment errors.

10. Works with recovery and collection vendors to validate overpayments and vendor invoices.

11. Provides feedback to modify queries when needed.

12. Reviews department policy and procedure manuals for accuracy and completeness, and makes recommendations for improvement.

13. Performs claim and trend analysis, validation and recovery of claims payment errors.

14. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree or equivalent combination of experience and education.

Years and Type of Experience Required:

Required:
- Five years of cost containment experience.

Language Skills

Required:
- English

Technical Competencies Computer Skills and Office Equipment
- Ability to use software and hardware of a computer to complete certain moderately-complex to complex tasks.
- Able to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard, 10 key and typing at 35 words/minute.
- Use of internet and some familiarity with SharePoint sites.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to problem solve.
- Ability to create and manipulate spreadsheets (i.e., data entry and format cells).
- Ability to work in databases.

Read, Interpret and Apply Information
- Ability to research information using available resources.
- Read and comprehend the information to analyze and apply logical thinking in making sound decisions.
- Understand and apply general instructions to appropriately and accurately process claims.
- Capacity to follow step-by-step and general directions, remain detail oriented and verify data from EOB's including HIPAA documentation.
- Ability to investigate and review claim from initial receipt.
- Ability to apply in-depth problem solving with more complex claims.
- Ability to read and interpret contract terms as related to payment policies for outpatient and inpatient claims.

Medical, Recovery & Billing Terminology
- Understanding of medical terminology used in claims documentation.
- Knowledge of other healthcare companies and third party insurance.
- Understanding of Cost Containment/Overpayment processes, such as COB.
- Familiarity with claims medical coding.
- Working knowledge of recovery practices.
- Understand DRG, capitation - per diem rules.
- Understand the different levels of care and applicable payment methodology.

System Familiarity
- Ability to use a claims adjudication system to process claims, such as Facets.
- Familiarity with image repository-review systems for the retrieval of documents.
- Ability to identify system issues to management for problem solving.

Communication Skills: Verbal, Written and Telephonic
- Ability to convey complex messages to a variety of audiences in an effective manner using proper language, grammar and style in the preparation of verbal and written messages.
- Skills to properly handle telephone inquiry with customers (providers, vendors and other health insurance carriers).
- Ability to prepare, edit and convey a variety of messages including presentations, settlement materials and updates.
- Ability to handle escalated issues through verbal and written messages.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability/Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermCS
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Recovery-Audit-Analyst-III-Job-VA-23450/2646454/264645426464542013-07-18AmerigroupCustomer Servicefull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-23058 # Positions 1
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 6/7/2013
Additional Locations ..

More information about this job:
Summary:

Supervises support level associates responsible for cost containment activities, and is accountable for team performance measurements and management reporting. Interfaces with health plans, vendors and other departments to aid in cost containment activity and recovery efforts.

Responsibilities:

1. Oversees all day-to-day activities of assigned associates; supervises staff including creating development plans for associates, providing timely and effective feedback, developing corrective action plans when needed and documenting all performance-related activity.

2. Manages inventories, projects and backlogs to department standards for turnaround times to include working with other areas impacting claims interest and performance guarantees. Load balance with other teams to maintain results and meet all service level agreements.

3. Works with internal and external customers to identify and implement new interface procedures, savings and analytical reports, including providing feedback on found root causes of errors.

4. Identify and assist in developing new procedures and workflows as needed to support growth, new products, and new markets with an emphasis on cost containment activities.

5. Work with Provider and Member Services to resolve problem situations and share the status of new on-going recovery projects.

6. Responsible for adhering to and managing to all Amerigroup and departmental policies and procedures, as well as HIPAA regulations.

7. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in related field, or equivalent experience.

Years and Type of Experience Required:

Required:
- Three years of operations or cost containment experience in managed care or financial institution.

Preferred:
- Claims processing experience.

Language Skills

Required:
- English

TECHNICAL COMPETENCIES

Computer Skills and Office Equipment
- Ability to use software and hardware of a computer to complete certain moderately-complex to complex tasks.
- Able to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard, 10 key and typing at 35 words/minute.
- Use of internet and some familiarity with SharePoint sites.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to problem solve.
- Ability to create and manipulate spreadsheets (i.e., data entry and format cells).
- Ability to work in databases.

Read, Interpret and Apply Information
- Ability to research information using available resources.
- Read and comprehend the information to analyze and apply logical thinking in making sound decisions.
- Understand and apply general instructions to appropriately and accurately process claims.
- Capacity to follow step-by-step and general directions, remain detail oriented and verify data from EOB's including HIPAA documentation.
- Ability to investigate and review claim from initial receipt.
- Ability to apply in-depth problem solving with more complex claims.
- Ability to read and interpret contract terms as related to payment policies for outpatient and inpatient claims.

Medical, Recovery & Billing Terminology
- Understanding of medical terminology used in claims documentation.
- Knowledge of other healthcare companies and third party insurance.
- Understanding of Cost Containment/Overpayment processes, such as COB (coordination of benefits).
- Familiarity with claims medical coding.
- Working knowledge of recovery practices.
- Understand DRG, capitation - per diem rules.
- Understand the different levels of care and applicable payment methodology.

System Familiarity
- Ability to use a claims adjudication system to process claims, such as Facets.
- Familiarity with an image repository-review system for the retrieval of documents.
- Ability to identify system issues to management for problem solving.
- Understanding of the system configuration concepts for benefits, pricing, and provider set up.

Communication Skills: Verbal, Written and Telephonic
- Ability to convey complex messages to a variety of audiences in an effective manner using proper language, grammar and style in the preparation of verbal and written messages.
- Skills to properly handle telephone inquiry with customers (providers, vendors and other health insurance carriers).
- Ability to prepare, edit and convey a variety of messages including presentations, settlement materials and updates.
- Ability to handle escalated issues through verbal and written messages.

BEHAVIORAL COMPETENCIES

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Sees the "big picture" (e.g., overall themes, trends, goals).
- Integrates and balances big-picture concerns with day-to-day activities.
- Establishes strategies for achieving individual or work unit goals.

Make Sound Decisions
- Analyzes, incorporates and applies new information and concepts.
- Recognizes symptoms that indicate problems.
- Makes sound decisions on everyday issues and problems.
- Makes timely decisions on problems/issues requiring immediate attention.

People Leadership

Develop/Support Organizational Talent
- Identifies and recruits/refers qualified people.
- Makes accurate evaluations of people's capabilities and fit.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Ensure Collaboration
- Provides sound rationale for recommendations.
- Solicits support for ideas.
- Ensures that own positions address others' needs and priorities.
- Builds relationships to create a foundation for future influence.

Results Leadership

Show Drive and Initiative
- Identifies what needs to be done and does it.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Conveys clear expectations for assignments.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Seeks additional resources to complete tasks when needed.

SCOPE INFORMATION

# Direct Reports: 15-30

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.

ermCS
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Supervisor-Cost-Containment-Job-VA-23450/2649515/264951526495152013-07-18AmerigroupCustomer Servicefull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-23060 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 6/7/2013
Additional Locations ..

More information about this job:
Summary:

Performs complex research and analysis to support business operations. Determines best practices and suggests how to improve current practices. Develops recommendations to solve problems and issues related to business operations and communicates with other departments as necessary. May perform special projects upon request and oversee the work of less experienced Business Analysts. Responsible for functional area and its interrelation with other areas in the capacity of gathering requirements, performing analysis, supporting the development and testing processes of assigned functional area and incorporating the applications, data, and associated technologies for supported areas. Analyzes and reports on complex business problems to be solved with automated systems or other resources. Provide expertise in identifying, evaluating and developing procedures that are cost effective and meet user requirements. Act as a resource to users of business applications and procedures.

Responsibilities:

1. Perform detailed requirements gathering, analysis, and process and data flow diagramming for simple processes of moderate complexity, considering the relationship between processes. Identify risks and multiple solutions.
2. Evaluate and test complex new/modified programs, applications and/or operating systems to ensure adherence to operational specifications. Monitor system and business functionality and performance. Document and track product defects. Coordinate problem resolution with development and/or product vendors.
3. Recommend improvements to existing procedures and business processes. 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 business and design issues.
7. Develop and run complex queries and reports for business analysis and trends. Perform data base 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. Functions as a liaison for IT and the business and other cross functional resources and departments.
12. Mentor and lead less experienced BAs and functional area associates.
13. Manage project related budgets.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience in a Business Analyst role is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Five years experience in business analysis or functional analysis role.

Preferred:
- Health care industry experience.

Certifications or Licensures

Preferred:
- CBAP (Certified Business Analyst Professional)

Language Skills

Required:
- English

Depending on the business area for a specific position, competency in one or more of the following may be Required:

Technical Competencies:
- Advanced understanding of the inter-relationship among various IT applications and systems.
- Demonstrate the ability to seek alternatives, new ideas, and/or approaches to problems.
- Advanced 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.
- Able to initiate conceptual ideas with practical applications.

Computer Skills and Office Equipment
- Intermediate: Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data. Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.

Spreadsheet Utilization and Management
- Intermediate: Proficient in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools.

Database Utilization and Database Management
- Intermediate: Proficient in database utilization including ability to conduct queries and design databases, and perform multiple table query design. Multi table. Ability to perform general data analysis. Accounts of records of a certain type.

Systems

Intermediate: Understanding of system's utilization and proficient retrieval of information and processing of the following systems:
- NetworX/Facets – build pricing based on provider contracts using Facets applications. Build benefit plans based on State regulations using Facets benefit applications.
- MACESS – contracts and claim images are stored. MACESS Workflow tool for contract life-cycle.
- Software products from Ingenix for prospective payment system (PPS) – pricing.
- Clearquest is used to track projects –knowledge and familiarity using a project inventory tracking system.

Applications/Tools
- Intermediate ability to leverage avaialbe tools such as:
TOAD, UltraEdit, Microsoft Project, Microsoft query analyzer SQL mgr, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity

Basic:
- General healthcare, who are our providers (hospitals phy ofc, ancil) who are payors (insurance companies),
- High level claims process, knowledge of general industry how it works.
- More specific knowledge around reimbursement methodology, fee schedules. Per case, per diem, DRG, % of charges, those terms. HIPAA.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping DRG codes, place of service codes (POS),
- Government Programs Specific Knowledge:
*Medicare Medicaid programs, CHIP and LTC.
*Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Gather and Document Requirements
- Intermediate: Ability to prepare simple to moderately-complex requirements documents. Ability to facilitate requirements gathering including determining the most efficient and effective way to capture the requirements, and managing kick off and subsequent status meetings. Ability to manage timelines and due dates. Ability to recognize and understand business changes that impact requirements and incorporate changes into documentation. Ability to read and re-read requirements documents multiple times while maintaining detail orientation.

Contracts
- Intermediate: Ability to read a contract and understand the operational requirements the contract creates. Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving-Analytics
- Basic critical thinking and problem solving methods.

Project Management
- Intermediate: Skilled in running a project utilizing standard project management tools, techniques and methodology. Keeps project on task.

Testing
- Intermediate: Functions independently in the creation of simple to moderately-complex test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

Behavioral Competencies:

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

SCOPE INFORMATION

# Direct Reports:

# 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.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

CB1

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Operations-Business-Analyst-III-Pharmacy-Job-VA-23450/2649520/264952026495202013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22921 # Positions 1
Location US-VA-Virginia Beach
Search Category Finance
Type Regular Full-Time (30+ hours) Posted Date 6/7/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for supporting leadership in the development, analysis and execution of the more complex administrative expense and/or capital forecasts and budgets for areas of direct responsibility, which are used to allocate current resources and estimate future financial needs. Routinely examines budgets to look for cost savings measures that allows for the efficient and most effective distribution of financial resources.

Responsibilities:

1. Examine budget and forecast estimates and proposals for completeness; accuracy; and conformance with established procedures, regulations, and organizational objectives. Maintains confidentiality of all corporate and financial data.

2. Prepare budget and forecast documents, and provide accurate and timely information to management.

3. Responsible for validating all metrics used as drivers in the budget/forecast models including target development and rolling forecast projections. Identifies future impact on forecast and budget.

4. Support business owners with development of SG&A budgets, forecasts and staffing projections, as well as, subsequent variance analyses and reporting. Maintains collaborative working relationships with business owners and other corporate customers.

5. Employ cost-benefit analysis to review financial requests, assess program tradeoffs, and explore alternative funding methods.

6. Examine past budgets and research economic and financial developments that affect the organization’s spending.

7. Evaluate proposals in terms of the organization’s priorities and financial resources and work with business owners to obtain justification then prioritize and devise possible alternatives when incremental funding sources limited.

8. Period reporting and monitoring of budget vs. actual results explaining variations and recommending revised procedures program cuts or reallocation of availability budgeted funds as well as inclusion of identified risks and opportunities in future forecasts and budgets.

9. Support business owners in the assessment of new and existing programs for efficiency and effectiveness, as well as financial viability.

10. Coordinate and support new business and development and acquisition activities through preparation of detailed administrative, implementation and capital budgets and by assisting in the preparation of pro forma financial statements. Work with management to update and communicate changes as needed and approved. Analysis monthly budget vs. actual variances, provide forecast trending and recommendations for achieving successful implementation within budget.

11. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor of Science degree accounting, finance, business with concentration in accounting, public finance, statistics; other degree acceptable with related experience.

Preferred:
- MBA or master in related field.

Years and Type of Experience Required:

Required:
- Minimum 3 to 5 years.

Certifications or Licensures

Preferred:
- CPA

Language Skills

Required:
- English

Functional Competencies
- Knowledge of generally accepted accounting principles.
- Knowledge of financial reporting documents that communicate financial information including income statement, balance sheets, cash flow reports and other financial documents.
- Advanced experience in the preparation and analysis of financial operating statements to explain business results, report budget information.
- Proficient in the use of top tier financial applications such as PeopleSoft and Hyperion.
- Extensive use of spreadsheet, database, data-mining, graphics, and word-processing software.
- Proficient in the preparation of multi-year operational planning through analysis of statements and application of quantitative, numeric and quantitative analytic skills.
- Proficient in financial analysis to evaluate past and comparative performance in projecting budget forecasts.
- Ability to support multi-year projections for bids, new markets, expansions and re-procurements.
- Proficient in presenting results in managerial review meetings.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 0

Budgetary $ Responsibility: Up to $950M annually SG&A and/or $100M capital.

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.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Budget-Analyst-III-Job-VA-23450/2649521/264952126495212013-07-18AmerigroupFinancefull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-23068 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 6/10/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for functional area and its interrelation with other areas in the capacity of gathering requirements, performing analysis, supporting the development and testing processes of assigned functional area and incorporating the applications, data, and associated technologies for supported areas. Analyzes and reports on complex business problems to be solved with automated systems or other resources. Provide 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 business applications and procedures. Provide consultation to users in the area of automated systems and department processes and less experienced business analysts. Researches, plans, coordinates and recommends software and system choices to meet the company’s business requirements. Utilizes knowledge and skills to address business challenges to improve efficiency and decision making, reduce redundancy, and enhance business results.

Responsibilities:

1. Perform detailed requirements gathering, analysis, and process and data flow diagramming for simple processes of moderate complexity, considering the relationship between processes. Identify risks and multiple solutions.

2. Evaluate and test complex new/modified programs, applications and/or operating systems to ensure adherence to operational specifications. Monitor system and business functionality and performance. Document and track product defects. Coordinate problem resolution with development and/or product vendors.

3. Work with business owners to analyze requirements and processes and with Information Technology as an advocate to ensure quality and timeliness of systems/project deliverables.

4. Use Standard Development Life Cycle (SDLC) methods or industry best practices. Understand strategic alignment of configuration solutions with business objectives.

5. Recommend improvements to existing procedures and business processes. Influence others to follow existing procedures.

6. Read and interpret a design document.

7. Read and interpret conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

8. Design moderately complex system configuration based upon business requirements ensuring optimization of auto-adjudication. Draft and maintain design documentation for all projects.

9. Configure all approved system changes and settings.

10. Use appropriate methods to resolve moderately complex design issues.

11. Develop and run moderately complex queries and reports for business analysis and trends. Perform data base updates.

12. Write, revise, and verify test plans for moderately complex systems in a software application.

13. Ensure compliance of current license and support agreements and requirements are met.

14. Manage multiple priorities at the same time.

15. Functions as a liaison for IT and the business and other cross functional resources and departments.

16. Lead cross-functional linked teams to address business or systems issues.

17. Mentor and lead less experienced BAs and functional area associates.

18. Manage project related budgets.

19. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience in a Business or Systems Analyst role is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Five years experience in systems analysis, or business analysis.

Preferred:
- Health Care industry experience.

Certifications or Licensures

Preferred:
- CBAP (Certified Business Analyst Professional)

Language Skills

Required
- English

Technical Competencies
- Advanced understanding of the inter-relationship among various IT applications and systems.
- Advanced proficiency with all applicable company supported software applications.
- Advanced understanding of how each department/health plan relates to the organization as a whole.
- 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 advanced knowledge of current technology trends.
- Able to develop and maintain customer relationships.

Computer Skills and Office Equipment - Intermediate
- Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks.
- Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse and keyboard.
- Use of internet.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.

Spreadsheet Utilization and Management - Intermediate
- Proficient in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools.

Database Utilization and Database Management - Intermediate
- Proficient in database utilization including ability to conduct queries and design databases, and perform multiple table query design.

Systems - Advanced
- Thorough understanding of system's utilization and considered a systems’ SME for the following systems:
- NetworX/Facets – build pricing based on provider contracts using Facets applications. Build benefit plans based on State regulations using Facets benefit applications.
- MACESS – contracts and claim images are stored. MACESS Workflow tool for contract life-cycle.
- Software products from Ingenix for prospective payment system (PPS) – pricing.
- Clearquest is used to track projects –knowledge and familiarity using a project inventory tracking system.

Applications/Tools - Intermediate
- Leverage available tools such as: TOAD, UltraEdit, Microsoft Project, Microsoft query analyzer SQL mgr, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity - Basic
- General understanding of the healthcare industry including, how the industry works, how claims are paid, who are providers (hospitals phy ofc, ancil), and who are payors (insurance companies).

Gather and Document Requirements - Intermediate
- Ability to prepare simple to moderately-complex requirements documents.
- Ability to facilitate requirements gathering including determining the most efficient and effective way to capture the requirements, and managing kick off and subsequent status meetings.
- Ability to manage timelines and due dates.
- Ability to recognize and understand business changes that impact requirements and incorporate changes into documentation.
- Ability to read and re-read requirements documents multiple times while maintaining detail orientation.

Contracts - Intermediate
- Ability to read a contract and understand the operational requirements the contract creates. Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving-Analytics

Demonstrate the ability to seek alternatives, new ideas, and/or approaches to problems. Advanced understanding of the strategic alignment of IT solutions with business objectives. Able to initiate conceptual ideas with practical applications.

Project Management - Intermediate
- Skilled in running a project utilizing standard project management tools, techniques and methodology. Keeps project on task.

Testing - Intermediate
- Functions independently in the creation of simple to moderately-complex test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Systems-Business-Analyst-III-Job-VA-23450/2653491/265349126534912013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USKeywords:
Call Center, Customer Service, CSR, Representative, Healthcare, Managed Care, Agent

Summary:

Associates are focused on understanding and meeting the needs of our customers by connecting with the mission and vision in their daily work activity. While working with our customers over the phone, Customer Care associates use their analytical skills to identify issues and proactively engage to solve problems during the call. While anticipating the needs of our customers, Customer Care associates demonstrate good listening skills, strong verbal and written communication skills to help influence our customers resulting in an amazing customer experience.

If you are looking for a way to make a difference in the lives of others by offering a little help to those in need, you are invited to further explore employment opportunities at Amerigroup.

Responsible for responding to either inbound inquiries or outreach calls from/to potential and existing AMERIGROUP members and providers. Responsibilities include providing accurate information/education/resolution about eligibility status, benefit coverage, provider network, credentialing status, authorization/referral status, demographic changes and all other non-claim issues.

This position is located in Tampa, FL.
We are recruiting for training classes to start June 3rd.

Responsibilities:
1. Function as an information source through telephonic assistance to members, providers, billing agencies, and various company/department staff.
2. Provide pleasant customer experience through superior customer service methods, problem solving and real-time issue resolution.
3. Interact with provider community and various departments to resolve issues involving the membership and credentialing status.
4. Explain benefits, eligibility status, enrollment processing procedures and status of authorizations and referrals to callers.
5. Assist with activities to ensure membership’s continuity of care.
6. Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls), complete health assessments for plan case management (Early Case Findings and Healthy Beginnings) and conduct membership surveys.
7. Process complaints, following established guidelines.
8. Maintain knowledge of state guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance.
9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education
Required:
• High school diploma or GED
Preferred:
• Some completed college courses or degree

Years and Type of Experience Required:
Required:
• Two years of experience in customer service or call center environment
Preferred:
• Managed care experience

Certifications or Licensures
Required:
• N/A

Language Skills
Required:
• English
Preferred:
• Other languages as determined by business need.

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment-Basic
• Ability to use software and hardware of a computer to complete certain simple tasks.
• Ability to use standard office equipment such as telephone, fax machine and copy machine.
• Working knowledge in a windows environment to include navigation skills using a mouse and keyboard and use of the Internet.
• Ability to review and draft correspondence in email system and word processing systems.
• Ability to use spreadsheets to review, organize and edit data.

Communication Skills: Verbal, Written and Call Handling-Basic
• Ability to use proper language, grammar and style in the preparation of verbal and written messages to convey a clear, concise, friendly and appropriate message to business partners and customers.
• Demonstrates skills to properly handle a telephone inquiry into the contact center. Properly greet the customer and provide information based on purpose for the call and script requirements.

Heath Care Industry Terminology
• Ability to understand basic health care industry terms, e.g. managed care, primary care physician, explanation of benefits, etc.

Read, Interpret and Apply Information
• Ability to read and comprehend the information and provide an explanation to the business partner or customer that is accurate and appropriate.
• Ability to research information using available resources.

Behavioral Competencies

Strategic Leadership
Be Strategic

• Demonstrates understanding of the organization's mission and strategies.
• Works to clarify and understand the broader purpose and mission of own work.
• Integrates and balances big-picture concerns with day-to-day activities.
• Generates innovative ideas and solutions to problems.
• Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions

• Approaches problems with curiosity and open-mindedness.
• Collects sufficient information to understand problems and issues.
• Analyzes problems and issues from different points of view.
• Applies accurate logic and common sense in making decisions

People Leadership
Develop/Support Organizational Talent

• Relates to people in an open, friendly, and accepting manner.
• Treats others with respect.
• Listens carefully and attentively to others’ opinions and ideas.
• Maintains positive relationships even under difficult or heated circumstances.
• Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration

• Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
• Appropriately involves others in decisions and plans that affect them.
• Provides honest, helpful feedback to others on their performance.
• Shares own experience and expertise with others.

Results Leadership
Show Drive and Initiative

• Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
• Maintains a consistent, high level of productivity.
• Takes personal responsibility to make decisions and take action.
• Does not easily give up in the face of unexpected obstacles.
• Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution

• Juggles many priorities and competing demands for one's time.
• Acts resourcefully to ensure that work is completed within specified time and quality parameters.
• Removes obstacles in order to move the work forward and/or get efforts back on track.
• Surfaces problems and issues before projects get derailed.

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 travel as needed and adhere to Amerigroup travel policies and procedures.
]]>http://www.amerigroup-jobs.com/job/Tampa-Customer-Care-Rep-I-33607/2524964/252496425249642013-07-18Amerigroupfull-timeUSDstarting0BSTampa, FL, USA
Job ID 2013-22603 # Positions 1
Location US-KS-Overland Park
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 4/16/2013
Additional Locations ..

More information about this job:
Summary:

The Health Promotion Coordinator is responsible for implementation of health promotion initiatives under the guidance of the Director or Manager as assigned. This includes identifying and communicating services, implementing health promotion related recruitment and enrollment activities at the local plan. The Health Promotion Coordinator develops strong relationships with the Public Health Department, School Systems and community based organizations and assists in ensuring AMERIGROUP members have access to appropriate health promotion programs and services.

Responsibilities:

1. Coordinates local and plan-wide Health Promotion programs and reports outcomes.

2. Meets and ensures compliance with all contract and regulatory requirements related to Health Promotion.

3. Educates members and providers about Health Promotion policies, programs and services.

4. Develops and ensures implementation of member community education programs, classes and materials that focus on prevention, health behavior modification and disease management (i.e., heath fairs, immunization efforts, newsletters, AMERITIPS etc.) and addresses the cultural and educational diversity of AMERIGROUP’s membership.

5. Develops the Health Promotion Plan for the health plan, incorporates corporate program components and ensures that the goals of health promotion are achieved.

6. Develops and implements Health Promotion programs for members, providers, AMERIGROUP Associates and the community at large.

7. Collaborates with Marketing to identify and implement activities/services that promote retention and assist with market penetration and growth.

8. May Conducts member/provider telephonic outreach efforts on a limited basis (this is not a full time telephonic outreach position).

9. Communicates community education programs and events to internal departments, providers, and members.

10. Develop business relationships and collaborative agreements with CBO’s, schools, health departments and other groups to implement community education and outreach programs.

11. Collects and submits data from Health Promotion activities and events including reports submitted to the Service Center and regulatory agencies.

12. Conducts and analyzes results of community based needs assessment as required.

13. Works with the Service Center to ensure all materials are submitted through appropriate approval processes prior to distribution to AMERIGROUP populations.

14. Contribute to the development and responsible for the timely distribution of written mass mailings to meet member health education needs, i.e., AMERITIPS, videos, newsletters, reminder post cards, etc.

15. Communicates and interfaces with Plan and Service Center departments, i.e., Disease Management, Case Management, Quality Management and /or Clinical Compliance as indicated by activities requiring their participation and/or feedback.

16. Reviews and maintains current Health Promotion policies.

17. Coordinates and leads the Health Education and Community Advisory Committee meetings.

18. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors in Health Education, Health Promotion, Community Health or related field. Significant related work experience will be considered in lieu of degree.

Preferred:
- Certification in Health Education (CHES) or State Teachers Certification in School Health.

Years and Type of Experience Required:

Required:
- 3-5 years experience in coordinating and implementing health promotion programs.

Preferred:
- 2 years in healthcare with managed care.
- Experience with expectant mothers.
- Experience with culturally diverse populations.

Specific Technical Skills

Required:
- Computer literate with word processing, PowerPoint, database and spreadsheet software.
- Able to organize events and programs.
- Ability to implement a work plan or communications campaign.
- Excellent communication and presentation skills.
- May require ability to screen and supervise temporary staff as needed.

Certifications or Licensure

Required:
- May require CHES Certification.
- Must possess a valid driver’s license and have access to a vehicle.

Other:

Required:
- Self-starter, ability to work with limited supervision.
- Work as a team player.
- Community awareness and knowledge.

Language Skills

Preferred:
- Bilingual (Spanish)

PHYSICAL REQUIREMENTS
- Must be able to move minor equipment and lift at least 45 lbs.
- Must be able to perform field work.

ermHO
]]>http://www.amerigroup-jobs.com/job/Overland-Park-Health-Promo-Coordinator-Plan-Job-KS-66062/2549316/254931625493162013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSOverland Park, KS, US
Job ID 2013-22644 # Positions 1
Location US-KS-Overland Park
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/22/2013
Additional Locations ..

More information about this job:
Summary:

Manages and overseas the utilization / care management process ensuring the delivery of essential services that effectively address the total healthcare needs of Amerigroup’s members using utilization and quality indicators to monitor effectiveness and implement change.

Responsibilities:

1. Implements and manages health care management, utilization, cost, and quality objectives 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. Evaluates program to ensure program compliance and identifies opportunities to improve the customer service and quality outcomes for our members.

3. Interfaces with other departments to ensure the complete integration of behavioral health and physical health, and effective delivery of case management and utilization management programs.

4. Overseas the development and execution of medical or behavioral health management and case management policies, procedures, and guidelines.

5. Ensures implementation and continued compliance by providing updates on specific medical management standards to Directors and staff.

6. 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.

7. Ensures that delegated medical management activities are contracted, reviewed and reported according to established criteria inclusive of auditing as indicated.

8. Ability to create collaborative relationships and programs with external community groups within the market for utilization management and case management programs.

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

10. Develop (or assist in the development) of the annual operating and capital budgets to sufficiently meet departmental needs.

11. Other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors Degree in a health care field or equivalent experience (equivalent experience equates to 6 years related experience in addition to the required 12 years experience).

Preferred:
- Masters Degree in a health care field, or
- or MBA with Health Care concentration.

For Behavioral Health Positions:
- Masters Degree in a Behavioral Health care field, or
- PhD or PsyD in a Behavioral Health care field.

Years and Type of Experience Required:

Required:
- Minimum of 10 years relevant clinical work experience, with at least 3 years of leadership/management experience, preferably in a managed care or behavioral health setting.

Preferred:
- Previous experience with NCQA accreditation and HEDIS reporting.

For Behavioral Health Positions:
- Previous management/leadership experience in behavioral health.

Certifications or Licensures

Required:
- RN, LCSW, LPC

Preferred:
- Certified Case Manager

For Behavioral Health:
- PhD or PsyD

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: 2-20

Budgetary $ Responsibility: As assigned

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.

CB:1

ermHO
]]>http://www.amerigroup-jobs.com/job/Overland-Park-AVP-Health-Care-Mgmt-Svcs-Behavioral-Health-Job-KS-66062/2559505/255950525595052013-07-18AmerigroupNursingfull-timeUSDstarting0BSOverland Park, KS, US
Job ID 2013-22677 # Positions 1
Location US-KS-Overland Park
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 4/25/2013
Additional Locations ..

More information about this job:
Summary:

This position is a telecommuting position located in the Brown and Doniphan Counties area of Kansas. You must reside in this area and cover the distance in your personal vehicle in these areas.

Responsible for conducting telephonic or face-to-face assessments for the identification, evaluation, coordination and management of Members’ needs, including physical health, behavioral health, social services and long term services and supports; develops the Member’s Individualized Service Plan to address those needs. Establishes relationships with referral sources and community resources, while maintaining strict member confidentiality and complying with all HIPAA requirements.

Responsibilities:

1. Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team.

2. Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members’ health care needs while optimizing efficiency and quality outcomes.

3. Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member’s PCP or treating physician and specialists in the development of an Individual Service Plan.

4. Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.

5. Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member’s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.

6. Reviews benefit options, acquires data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors degree from an accredited college or university in Nursing, Social Work, Counseling, Special Education, Sociology, Psychology, Gerontology, or a closely related field, State Waiver (NM), or a minimum of six years of experience working for State agencies directly or by contract.
- Bachelors Degree in an unrelated field and at least two years of geriatric experience

Preferred:
- Masters degree from an accredited college or university in Nursing, Social Work, Counseling, Special Education, Sociology, Psychology, Gerontology, or a closely related field.

Years and Type of Experience Required:

Required:
- Minimum of two years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role.

Preferred:
- Experience in home health, health care, discharge planning, behavioral health, collaborating with nursing facilities, community resources, and/or other home and community-based agencies.
- Experience working with Medicare, Medicaid, and managed care programs.

Certifications or Licensures

Required:
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.
- Additional state mandated certification, where appropriate.

Language Skills

Required:
- English

Preferred:
- Bilingual (ability to read, write, and speak).

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with case or utilization management data systems.
- Solid understanding of the healthcare industry and government insurance programs.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Overland-Park-LTSS-Service-Coordinator-Northeast-Brown-and-Doniphan-Counties-Only-Telecommuting-Job-KS-66062/2566929/256692925669292013-07-18AmerigroupCase Managementfull-timeUSDstarting0BSOverland Park, KS, US
Job ID 2013-22590 # Positions 1
Location US-KS-Overland Park
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/30/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

2. Predicts and plans for patient’s needs from pre-admission, through acute and sub acute 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. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

7. 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.

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

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of 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.

Certifications or Licensures

Required:
- RN
- Must possess a valid driver’s license and access to a motor vehicle.

Preferred:
- Certified Professional Healthcare Management

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Overland-Park-RN%2C-Utilization-Manager-Outpatient-Job-KS-66062/2594748/259474825947482013-07-18AmerigroupNursingfull-timeUSDstarting0BSOverland Park, KS, USKeywords:
Call Center, Customer Service, CSR, Representative, Healthcare, Managed Care, Agent

Summary:

The West Regional Support Center, with operations in Houston, TX, delivers a variety of support resources to members of Amerigroup's members in Texas and across the Western US.

Associates are focused on understanding and meeting the needs of our customers by connecting with the mission and vision in their daily work activity. While working with our customers over the phone, Customer Care associates use their analytical skills to identify issues and proactively engage to solve problems during the call. While anticipating the needs of our customers, Customer Care associates demonstrate good listening skills, strong verbal and written communication skills to help influence our customers resulting in an amazing customer experience.

If you are looking for a way to make a difference in the lives of others by offering a little help to those in need, you are invited to further explore employment opportunities at Amerigroup.

Responsible for responding to either inbound inquiries or outreach calls from/to potential and existing AMERIGROUP members and providers. Responsibilities include providing accurate information/education/resolution about eligibility status, benefit coverage, provider network, credentialing status, authorization/referral status, demographic changes and all other non-claim issues.

This position is located in Houston, TX.
We are recruiting for a training class to start December 3, 2012. Training hours will be 8:30 AM- 5:00 PM Monday- Friday. Newly hired associates will need to be able to work shifts between 7 am and 8 pm, M-F.

Responsibilities:
1. Function as an information source through telephonic assistance to members, providers, billing agencies, and various company/department staff.
2. Provide pleasant customer experience through superior customer service methods, problem solving and real-time issue resolution.
3. Interact with provider community and various departments to resolve issues involving the membership and credentialing status.
4. Explain benefits, eligibility status, enrollment processing procedures and status of authorizations and referrals to callers.
5. Assist with activities to ensure membership’s continuity of care.
6. Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls), complete health assessments for plan case management (Early Case Findings and Healthy Beginnings) and conduct membership surveys.
7. Process complaints, following established guidelines.
8. Maintain knowledge of state guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance.
9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education
Required:
• High school diploma or GED
Preferred:
• Some completed college courses or degree

Years and Type of Experience Required:
Required:
• Two years of experience in customer service or call center environment
Preferred:
• Managed care experience

Certifications or Licensures
Required:
• N/A

Language Skills
Required:
• English
Preferred:
• Other languages as determined by business need.

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment-Basic
• Ability to use software and hardware of a computer to complete certain simple tasks.
• Ability to use standard office equipment such as telephone, fax machine and copy machine.
• Working knowledge in a windows environment to include navigation skills using a mouse and keyboard and use of the Internet.
• Ability to review and draft correspondence in email system and word processing systems.
• Ability to use spreadsheets to review, organize and edit data.

Communication Skills: Verbal, Written and Call Handling-Basic
• Ability to use proper language, grammar and style in the preparation of verbal and written messages to convey a clear, concise, friendly and appropriate message to business partners and customers.
• Demonstrates skills to properly handle a telephone inquiry into the contact center. Properly greet the customer and provide information based on purpose for the call and script requirements.

Heath Care Industry Terminology
• Ability to understand basic health care industry terms, e.g. managed care, primary care physician, explanation of benefits, etc.

Read, Interpret and Apply Information
• Ability to read and comprehend the information and provide an explanation to the business partner or customer that is accurate and appropriate.
• Ability to research information using available resources.

Behavioral Competencies

Strategic Leadership
Be Strategic

• Demonstrates understanding of the organization's mission and strategies.
• Works to clarify and understand the broader purpose and mission of own work.
• Integrates and balances big-picture concerns with day-to-day activities.
• Generates innovative ideas and solutions to problems.
• Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions

• Approaches problems with curiosity and open-mindedness.
• Collects sufficient information to understand problems and issues.
• Analyzes problems and issues from different points of view.
• Applies accurate logic and common sense in making decisions

People Leadership
Develop/Support Organizational Talent

• Relates to people in an open, friendly, and accepting manner.
• Treats others with respect.
• Listens carefully and attentively to others’ opinions and ideas.
• Maintains positive relationships even under difficult or heated circumstances.
• Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration

• Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
• Appropriately involves others in decisions and plans that affect them.
• Provides honest, helpful feedback to others on their performance.
• Shares own experience and expertise with others.

Results Leadership
Show Drive and Initiative

• Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
• Maintains a consistent, high level of productivity.
• Takes personal responsibility to make decisions and take action.
• Does not easily give up in the face of unexpected obstacles.
• Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution

• Juggles many priorities and competing demands for one's time.
• Acts resourcefully to ensure that work is completed within specified time and quality parameters.
• Removes obstacles in order to move the work forward and/or get efforts back on track.
• Surfaces problems and issues before projects get derailed.

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 travel as needed and adhere to Amerigroup travel policies and procedures.
]]>http://www.amerigroup-jobs.com/job/Houston-Member-Services-Representative-TX-77036/2236628/223662822366282013-07-18Amerigroup2850101full-timeUSDstarting0BSHouston, TX, USKeywords:
Call Center, Customer Service, CSR, Representative, Healthcare, Managed Care, Agent

Summary:

The West Regional Support Center, with operations in Houston, TX, delivers a variety of support resources to members of Amerigroup's Health Plans.

Associates are focused on understanding and meeting the needs of our customers by connecting with the mission and vision in their daily work activity. While working with our customers over the phone, Customer Care associates use their analytical skills to identify issues and proactively engage to solve problems during the call. While anticipating the needs of our customers, Customer Care associates demonstrate good listening skills, strong verbal and written communication skills to help influence our customers resulting in an amazing customer experience.

If you are looking for a way to make a difference in the lives of others by offering a little help to those in need, you are invited to further explore employment opportunities at Amerigroup.

Responsible for responding to either inbound inquiries or outreach calls from/to potential and existing AMERIGROUP members and providers. Responsibilities include providing accurate information/education/resolution about eligibility status, benefit coverage, provider network, credentialing status, authorization/referral status, demographic changes and all other non-claim issues.

This position is located in Houston, TX.
We are recruiting for training classes to start in 2ndquarter 2013.

Responsibilities:
1. Function as an information source through telephonic assistance to members, providers, billing agencies, and various company/department staff.
2. Provide pleasant customer experience through superior customer service methods, problem solving and real-time issue resolution.
3. Interact with provider community and various departments to resolve issues involving the membership and credentialing status.
4. Explain benefits, eligibility status, enrollment processing procedures and status of authorizations and referrals to callers.
5. Assist with activities to ensure membership’s continuity of care.
6. Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls), complete health assessments for plan case management (Early Case Findings and Healthy Beginnings) and conduct membership surveys.
7. Process complaints, following established guidelines.
8. Maintain knowledge of state guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance.
9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education
Required:
• High school diploma or GED
Preferred:
• Some completed college courses or degree

Years and Type of Experience Required:
Required:
• Two years of experience in customer service or call center environment
Preferred:
• Managed care experience

Certifications or Licensures
Required:
• N/A

Language Skills
Required:
• English
Preferred:
• Other languages as determined by business need.

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment-Basic
• Ability to use software and hardware of a computer to complete certain simple tasks.
• Ability to use standard office equipment such as telephone, fax machine and copy machine.
• Working knowledge in a windows environment to include navigation skills using a mouse and keyboard and use of the Internet.
• Ability to review and draft correspondence in email system and word processing systems.
• Ability to use spreadsheets to review, organize and edit data.

Communication Skills: Verbal, Written and Call Handling-Basic
• Ability to use proper language, grammar and style in the preparation of verbal and written messages to convey a clear, concise, friendly and appropriate message to business partners and customers.
• Demonstrates skills to properly handle a telephone inquiry into the contact center. Properly greet the customer and provide information based on purpose for the call and script requirements.

Heath Care Industry Terminology
• Ability to understand basic health care industry terms, e.g. managed care, primary care physician, explanation of benefits, etc.

Read, Interpret and Apply Information
• Ability to read and comprehend the information and provide an explanation to the business partner or customer that is accurate and appropriate.
• Ability to research information using available resources.

Behavioral Competencies

Strategic Leadership
Be Strategic

• Demonstrates understanding of the organization's mission and strategies.
• Works to clarify and understand the broader purpose and mission of own work.
• Integrates and balances big-picture concerns with day-to-day activities.
• Generates innovative ideas and solutions to problems.
• Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions

• Approaches problems with curiosity and open-mindedness.
• Collects sufficient information to understand problems and issues.
• Analyzes problems and issues from different points of view.
• Applies accurate logic and common sense in making decisions

People Leadership
Develop/Support Organizational Talent

• Relates to people in an open, friendly, and accepting manner.
• Treats others with respect.
• Listens carefully and attentively to others’ opinions and ideas.
• Maintains positive relationships even under difficult or heated circumstances.
• Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration

• Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
• Appropriately involves others in decisions and plans that affect them.
• Provides honest, helpful feedback to others on their performance.
• Shares own experience and expertise with others.

Results Leadership
Show Drive and Initiative

• Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
• Maintains a consistent, high level of productivity.
• Takes personal responsibility to make decisions and take action.
• Does not easily give up in the face of unexpected obstacles.
• Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution

• Juggles many priorities and competing demands for one's time.
• Acts resourcefully to ensure that work is completed within specified time and quality parameters.
• Removes obstacles in order to move the work forward and/or get efforts back on track.
• Surfaces problems and issues before projects get derailed.

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 travel as needed and adhere to Amerigroup travel policies and procedures.CB1
]]>http://www.amerigroup-jobs.com/job/Houston-Customer-Care-Representative-TX-77036/2375278/237527823752782013-07-18Amerigroup28500101full-timeUSDstarting0BSHouston, TX, US
Job ID 2013-23097 # Positions 1
Location US-LA-Baton Rouge
Search Category Administrative Services
Type Regular Full-Time (30+ hours) Posted Date 6/13/2013
Additional Locations ..

More information about this job:
Summary:

Under moderate supervision, performs a variety of administrative functions in support of an executive and/or department, with limited latitude for independent judgment. Consults with senior level peers on non-complex projects. Relies on instructions and pre-established guidelines.

Responsibilities:

1. Manages executive/department schedule.

2. Assists in planning and preparation of meetings.

3. Prepares documents/reports/correspondence from dictation and/or handwritten notes.

4. Opens incoming mail.

5. Processes appointments, updates, deletion to schedule.

6. Plans and prepares travel for executive and/or department.

7. Prepares expense reports as needed.

8. Answers and manages incoming and out-going calls to executive and/or department, taking accurate messages.

9. Prepares presentation material for executive and/or department as needed.

10. Prepares, orders, distributes office supplies.

11. Acts as an administrative resource for executive/department.

12. Assist in design of electronic file systems and maintains electronic and paper files. Also, maintains electronic/paper files for executive and/or department.

13. Prepares requests for capital expenditures.

14. Provides copy/fax assistance.

15. Assists with projects as needed.

16. Maintains department organizational chart.

17. Prepares bi-weekly timesheet for executive and others in department as needed.

18. Prepares new hire, security, temporary and other paperwork necessary.

19. Prepares weekly management reports as needed.

20. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High School or equivalent with one year additional education.

Years and Type of Experience Required:

Required:
- Minimum of 2 years experience as administrative support to an Executive and/or Department.

Specific Technical Skills

Required:
- Word, Outlook, PowerPoint, Excel required with testing scores of 80% or better on overall skills with 2 years use of software in a business environment.
- Ability to exercise judgment and maintain confidentiality.
- Practices good telephone etiquette skills, customer service and community skills.
- Good organization skills, ability to set priority and work under pressure with changing deadlines.
- Ability to multi-task while maintaining quality and meeting deadlines.
- Ability to operate a multi-line phone and other media devices.

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.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Baton-Rouge-Administrative-Assistant-Job-LA-70801/2662606/266260626626062013-07-18AmerigroupAdministrative Servicesfull-timeUSDstarting0BSBaton Rouge, LA, US
Job ID 2013-23018 # Positions 1
Location US-CA-Thousand Oaks
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 6/4/2013
Additional Locations ..

More information about this job:
Summary:

The incubment will assist the COO in the fiscal and operational management of the Health Plan. Serves as the liaison to all Virginia Beach support services. Have local responsibility for network development, provider partnerships, provider relations, and quality management programs, performance management/improvement, budgets, complaints and appeals, monthly financials, and reporting. Responsible for identifying, developing and implementing best practices and coordinating implementation of Health Plan initiatives. The incumbent will work collaboratively with Health Plan Services, HP SME’s and Home Office SME’s.

Responsibilities:

1. Establish objectives and annual goals in conjunction with the Health Plan CEO/COO, Health Plan Operations, and AMERIGROUP key initiatives.

2. Facilitate Plan requirements with Corporate initiatives; promote Plan concerns and enhance communications between respective business owners.

3. Analyze, evaluate and implement best practices.

4. Support Plan Executive Management teams by monitoring plan performance; analyze for gaps and opportunities for OpEx.

5. Manage assigned projects including the development of business processes, workflows and training programs to assist the Health Plans in improving their Operational Excellence.

6. Provide leadership for Health Plan Operational Excellence programs.

7. Develop and implement tools for monitoring and evaluating performance objectives.

8. Coordinate implementation of Health Plan initiatives.

9. Recognizes and utilizes appropriate channels for communication, encourages two-way communication with Plan and Home Office staff to participate in creative program development resulting in improved efficiency and enhanced job performance.

10. Serves as the liaison to all support services, Claims, Enrollment, MPS, Finance, Business Control, Med/Finance, Regulatory Compliance, IT, etc., in Virginia Beach. Participates in cross-company operational activities on an ad hoc (e.g., Service Center Audits) and ongoing (e.g., MOR; QOR) basis.

11. Develops and manages provider contracts and partnerships to achieve quality, cost management, and strategic business development objectives; develops and negotiates strategic provider contracts on behalf of the Plan.

12. Responsible for and leads the Plans performance management/earnings improvement activities. Assists in developing policy and programs to achieve business results through effective financial management.

13. Assists CEO with development of the Plan’s annual administrative, medical, and capital budget process.

14. Assists CEO with management of monthly reporting and review of financials/accruals.

15. Appeals Grievances: Responsible for the Plan’s complaint, appeals, pended claims, and claims research functions.

16. Other Duties as Assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors degree in Accounting, Finance or Business.

Preferred:
- Advanced Degree in a related field.

Years and Type of Experience Required:

Required:
- Ten years of in-depth experience in the HMO/healthcare field.
- Five years project management/ program implementation experience in the Health Plan environments.
- Five years of successful management experience.

Specific Technical Skills

Preferred:
- Proficient in the use of MS Office (Visio, Excel, Access, Word)

Other:

Required:
- Strong interpersonal skills.
- Excellent verbal and written communication skills.
- Strong leadership skills with the ability to influence and manage.
- Knowledge of managed care and public sector health care, e.g., Medicaid.
- Ability to quickly understand all major functions within the Health Plan environment, and address issues globally.
- Strong financial management skills.
- Ability to understand major objectives and break them down into meaningful action steps.
- Strong management skills including prioritization of concurrent projects and ability to promote a team environment.
- Strong problem-solving, analytical, and organizational skills with attention to detail.
- Ability to work with multiple Health Plans to achieve goals.
- Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION

# Direct Reports: 1-5

# Indirect Reports:

Budgetary Responsibility:

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 adhere to AMERIGROUP’s travel policies.

Job Title: VP Health Plan Operations

Job Grade: 23

Salary Range: $107,021 - $142,695 - $178,369

MJO: 20%

LTI: 15k

ermHO
]]>http://www.amerigroup-jobs.com/job/Cerritos-VP-Health-Plan-Operations-Job-CA-90701/2640299/264029926402992013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSThousand Oaks, CA, US
Job ID 2013-22771 # Positions 1
Location US-CA-Thousand Oaks
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/29/2013
Additional Locations ..

More information about this job:
Summary:

The Vice President of Clinical Quality Management is responsible, in conjunction with the Chief Medical Officer or his designee, for developing, coordinating, and implementing clinical quality initiatives within all health plans and departments of AMERIGROUP Corporation. This 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 state/federal regulatory agencies and collaborates with Government Relations leaders to meet external quality information needs. The VP Clinical Quality Management provides operational leadership for companywide HEDIS reporting, member/provider satisfaction surveying, appeals processing, QM scorecard reporting, HIPAA privacy compliance, and QM new business development. The VP Clinical Quality Management works to establish and promote a culture of operational excellence.

Responsibilities:

1. Provides leadership for implementation of the comprehensive Clinical Quality Management Program for AMERIGROUP Corporation or the individual plan to meet the demographic and epidemiological needs of the population served.

2. Establishes objectives and annual goals in conjunction with the Chief Medical Officer or his designee. 2. Promotes organization--wide understanding, communication, and coordination of the Clinical Quality Management Program.

3. Oversees the companywide QM Scorecard reporting including analyzing validity of Clinical Quality management data/reports from a clinical perspective.

4. Provides leadership for the development, implementation, and evaluation of Clinical Quality improvement action plans for clinical quality improvement activities.

5. Oversees the member complaint process across the company.

6. Oversees the privacy compliance process across the company.

7. Oversees the centralized appeal process across the company.

8. Provides leadership for and supervises the member/provider satisfaction survey process.

9. Oversees Health Employer Data Information Sets (HEDIS) reporting and provides leadership to the development and realization of action plans to achieve target improvement goals.

10. Supports the health plans’ External Quality Review Organization (EQRO) state audit processes.

11. Oversees and provides leadership for the companywide Quality Improvement Council (QIC).

12. Provides supervision and leadership to QM representation in new business activities (RFP responses, new market/product development, and state contract changes etc.)

13. Provides organizational leadership to comply with National Committee for Quality Assurance (NCQA) standards, or other accrediting bodies such as URAC and AAAHC.

14. Provides leadership and makes recommendations for provider recredentialing in the areas of medical record reviews, Clinical Quality indicators, performance and quality of care actions.

15. Assures compliance with State and Federal quality improvement/assurance requirements.

16. Collaborates with Government Relations and External Communication leaders to meet the QM information needs of customers.

17. Oversees delegated services QM auditing including ensuing evaluations/recommendations for improvement.

18. Develops the annual operating and capital budgets to sufficiently meet departmental needs and ensures that department stays within budget and accounts for variances.

19. Interviews, manages, evaluates, and develops new and existing departmental staff.

20. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor Degree

Preferred:
- MSN, MPH, MPA

Years and Type of Experience Required:

Required:
- Must have twelve or more years of current progressive experience in quality management, and quality improvement, risk management, and/or utilization management in a managed care setting and seven years of leadership/management experience.
- Previous NCQA accreditation and HEDIS reporting experience required.
- CPHQ

Preferred:
- Experience with the urban Medicaid population preferred.

Specific Technical Skills

Required:
- Knowledge of basic computers including work processing and spread sheets.

Preferred:
- Experience with data base applications.

Certifications or Licensure

Preferred:
- Current RN state license (as may be required by Plan.)

Other:
- Strong knowledge base in areas of quality improvement and risk management.
- Excellent verbal and written communication skills.
- 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 problem solving skills.
- Strong organizational skills.
- Ability to develop and give presentations and to assume the role of facilator.
- Ability to handle multiple tasks.
- Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION

# Direct Reports: Will have direct reports.

# Indirect Reports: Will have indirect reports.

Budgetary $ Responsibility: Will be responsible for departmental budget.

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 to adhere to AMERIGROUP’s travel policies.

AGP Job Title: VP QM

AGP Grade level: 23

AGP Compensation range: $107,021k - $142,695- $178,369k

AGP MJO: 20%

AGP LTI: $15K

ermHO
]]>http://www.amerigroup-jobs.com/job/Thousand-Oaks-VP-Quality-Management-Plan-Job-CA-91319/2582905/258290525829052013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSThousand Oaks, CA, US
Job ID 2013-22770 # Positions 1
Location US-CA-Newbury Park
Search Category Health Care Administration
Type Regular Full-Time (30+ hours) Posted Date 5/6/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for the development, implementation and oversight of integrated Medical Management primarily in the Health Plan. These initiatives will include the establishment of indicators for monitoring and evaluating quality care, appropriateness, continuous improvement, member satisfaction, utilization, and case management across the continuum of care to members. Provides education in the area of healthcare management. Serves as liaison to state regulatory agencies. Participates in accreditation of plan with the National Committee of Quality assurance. Develops professional relationships with community agencies.

Responsibilities:

1. Directs and provides leadership for designing, developing, and implementing the local Plan integrated medical management program to meet the demographic and epidemiological needs of the population serviced.

2. Directs Healthcare Management Program for membership including disease management, case management, and utilization management.

3. Establishes objectives and annual goals in conjunction with the Medical Director to meet objectives established by the Plan CEO/COO and corporate HCMS.

4. Promotes understanding, communication, and coordination of Integrated Medical Management Programs across the health plan.

5. Works with Provider Relations, Quality Management and Health Promotions to develop and implement effective provider communications, quality assurance and member outreach programs.

6. Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.

7. Coordinates on a quarterly basis reporting of quality initiatives to all appropriate plan committees.

8. Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.

9. Monitors and makes recommendations for oversight of appropriate delegated services.

10. Develops the annual operating and capital budget: ensures that departments stay within budget and accounts for variances.

11. Works collaboratively with key health care professionals toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problems resolution.

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors Degree in a health care field or equivalent experience (equivalent experience equates to 6 years related experience in addition to the required 12 years experience).

Preferred:
- Masters Degree in a health care field, or
- MBA with Health Care concentration.

Years and Type of Experience Required:

Required:
- Minimum of 12 years relevant clinical work experience and at least 7 years of leadership/management experience preferably in a managed care setting , with at least 5 years of clinical experience (post Masters for Behavioral Health).
- Previous experience with NCQA accreditation and HEDIS reporting.

Certifications or Licensures

Required:
- RN, LCSW, LPC

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

SCOPE INFORMATION

# Direct Reports: 5-30

# Indirect Reports: varies

Budgetary $ Responsibility: As assigned

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.

AGP Job Title: VP HCMS

AGP Grade level: 23

AGP Compensation range: $107,021k - $142,695- $178,369k

AGP MJO: 20%

AGP LTI: $15K

ermHO
]]>http://www.amerigroup-jobs.com/job/Newbury-Park-VP-Healthcare-Mgmt-Svcs-Job-CA-91319/2582906/258290625829062013-07-18AmerigroupHealth Care Administrationfull-timeUSDstarting0BSNewbury Park, CA, US
Job ID 2013-22738 # Positions 1
Location US-CA-Thousand Oaks
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/8/2013
Additional Locations ..

More information about this job:
Summary:

The incumbent will assist the Health Plan CEO in the fiscal and or operational management of the Health Plan. Responsibilities include serving as the liaison to all Virginia Beach support services and regulators, local network development, provider partnerships, provider relations, medical, case and quality management programs, performance management/improvement, budgets, complaints and appeals, regulatory and contractual compliance, monthly financials, and reporting. Provide input on overall strategic direction especially strategies affected by service delivery matters, operations, practices and policies.

Responsibilities:

1. Establish overall standards, policies and objectives for all Health Plans in accordance with applicable regulatory requirement; ensure alignment and support with overall mission, goals and objectives.

2. Act as a liaison to regulators for operational matters and to home office personnel by working cooperatively to ensure development and nurturing of a collaborative work environment to facilitate involvement in planning and operations as appropriate.

3. Serves as the liaison to all support services, Claims, Enrollment, MPS, Finance, Business Control, Med/Finance, Regulatory Compliance, IT, etc., in Virginia Beach. Participates in cross-company operational activities on an ad hoc (e.g., Service Center Audits) and ongoing (e.g., MOR; QOR) basis.

4. Accountable for the oversight of all health plan medical management programs including: concurrent review, pre-certification, discharge planning, case management, disease management, provider profiling, quality management, accreditation, health promotion and outreach. Facilitates and collaborates with NCC medical management staff to identify gaps and improve processes.

5. Accountable for the oversight of the design and development of provider contracts and partnerships to achieve quality, cost management, and strategic business development objectives; develops and negotiates strategic provider contracts on behalf of the Plan.

6. May be accountable for other areas of Plan operations including, but not limited to, marketing, operations, and specific products such as long term care.

7. Leads and manages the Plans performance management/earnings improvement activities. Assists in developing policy and programs to achieve business results through effective financial management.

8. Assists CEO with development and management of the Plan’s annual administrative, medical and capital budget process, monthly reporting and review of financials/accruals.

9. Coach and develop team members; adhere to the Company’s recruitment, selection, termination, and performance management processes. Act as advisor to subordinate managers or staff to help meet established schedules.

10. Manage the Plan’s complaint, appeals, pended claims, and claims research functions.

11. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in relevant field of work or equivalent experience in Business, Healthcare Administration or related field.

Preferred:
- Master’s degree.

Years and Type of Experience Required:

Required:
- At least 14 years of relevant experience including ten years of in-depth experience in the HMO/healthcare field.
- At least 10 years of leadership/management experience.

Language Skills

Required:
- English

Functional Competencies
- Comprehensive knowledge of managed care delivery systems and how they can work to improve quality of care and reduce costs.
- Strong financial management skills.
- Proven project management skills with demonstrated ability in organizing, planning and executing development project from conception through implementation.
- Ability to understand major objectives and break them down into meaningful action steps.
- Ability to understand business strategy and formulate concise solutions to managed care problems.
- Proven ability to affect change and meet business goals, monitor progress and take corrective action when necessary.
- Proven ability and prior experience with negotiating and maintaining public and legislative relationships.

SCOPE INFORMATION

# Direct Reports: As Assigned

# Indirect Reports: As Assigned

Budgetary $ Responsibility: As Assigned

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.

AGP Job Title: COO- Plan

AGP Grade level: 26

AGP Compensation range: $180,000k - $240,000k- $300,00k

AGP MJO: 75-85k

AGP LTI: Based on performance

ermHO
]]>http://www.amerigroup-jobs.com/job/Thousand-Oaks-COO-Health-Plan-Job-CA-91319/2587598/258759825875982013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSThousand Oaks, CA, US
Job ID 2013-21716 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 1/23/2013
Additional Locations ..

More information about this job:
Summary:

Key leadership role responsible for leading the development, implementation and coordination of a comprehensive health care program that will assist Health Care Management Services, Medical Management, and Utilization management, resulting in improved health outcomes for members.

Responsibilities:

1. Assists leadership peers in the 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 and Managers.

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

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

5. Provide contracting feedback recommendations based on identified network gaps and feedback from CMS associates.

6. Participates in complaint resolution and inquiries pertaining to HCMS programs.

7. Assists in developing clinical management guidelines, policies, and strategies.

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

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

10. Ensures program deliverables by monitoring established goals and implementing improvement strategies accordingly.

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

12. Ensures compliance with state reporting on healthcare management activities for accuracy.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors Degree in related Health/Nursing field

Preferred:
- Master’s Degree in related Health/Nursing field

Years and Type of Experience Required:

Required:
- Minimum of seven years clinical work experience, with at least three years of leadership/management experience.

Certifications or Licensures

Required:
- RN,LCSW, or LPC

Preferred:
- Certified Case Manager

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: 2-20

Budgetary $ Responsibility: As assigned

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Director-Health-Care-Mgmt-Svcs-Utilization-Mgmt-Outpatient-Job-NY/2378402/237840223784022013-07-18AmerigroupNursingfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-21622 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 1/23/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective care management, utilization of health, mental health, and substance abuse services. CB1

Responsibilities:

1. Manages and oversees teams responsible for various HCMS functions including utilization management, case finding and coordinating those cases that involve co-morbid conditions and need to be part of the case management/disease management track.

2. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.

3. Works with providers to establish short and long term goals that meet the member’s need, functional abilities and referral sources requirements.

4. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.

5. Coordinates the identifications of members with potential for high risk complications; assesses members’ present level of physical/mental impairment utilizing defined criteria and methodology.

6. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.

7. Review benefit systems and cost benefit analysis.

8. Evaluates the member against level of care criteria.

9. Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma or Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s Degree in related Health/Nursing field or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of five years experience in health Care Management and at least one year of leadership/management experience.

Certifications or Licensures

Required:
- RN

Preferred:
- Certified Case Manager

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
- Strong communication skills, both written and verbal; articulate, persuasive & Influential; systematic and timely.
- Demonstrate project management experience in organizing, planning and executing large-scale projects from conception through implementation.
- Experience in leading and developing people.

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: 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 as needed and adhere to Amerigroup travel policies and procedures.

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Manager-Utilization-Management-Inpatient-Admissions-Job-NY/2391689/239168923916892013-07-18AmerigroupNursingfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-21720 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 2/19/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for managing members experiencing complex or catastrophic illness, high risk pregnancy, injury and/or specialty illnesses such as diabetes, HIV, transplant, behavioral health conditions, etc., to ensure cost effective and efficient utilization of health services. Conducts continuous skills assessment, planning, implementation, coordination, monitoring and evaluation.

Responsibilities:

1. Obtains an accurate member history, conducts an assessment of biopsychosocial factors, and assesses clinical information to develop care plans including a member support system.

2. Establishes prioritized short and long term goals in collaboration with the member that meet the member’s needs and the referral source’s requirements.

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

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

5. Collaborates with the member’s PCP and specialists in the development of the plan of care to ensure that members’ physical needs are addressed; communicates care objectives to appropriate individuals/departments/referral sources.

6. Provide case management and/or disease management services to members, as identified by a health plan’s referral process.

7. May be required to conduct field visits.

8. May be required to perform service authorization duties using prescribed criteria and responsibilities as assigned and required by the Plan

9. Acts as an advocate for an individual’s health care needs.

10. Reviews benefit systems and cost benefit analysis; evaluates the quality and necessity of applicable services; identifies members that would benefit from an alternative level of care; acquires data and evaluates necessary health services for cost containment; documents effectiveness of case management services

11. Participates in Quality Improvement processes and serves on internal and external committees as required.

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of three years clinically related experience.

Preferred:
- Experience working on the community level and with community agencies.
- Experience in managed care, case management and discharge planning.

Certifications or Licensures

Required:
- Active licensed RN.
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.

Preferred:
- Certified Case Manager.

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Telephonic-Case-Manager-RN-OBMaternity-Job-NY/2437129/243712924371292013-07-18AmerigroupNursingfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-21717 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 2/21/2013
Additional Locations ..

More information about this job:
Summary:

Key leadership role responsible for leading the development, implementation and coordination of a comprehensive health care program that will assist Health Care Management Services, Medical Management, and/or Utilization management, resulting in improved health outcomes for members. CB1

Responsibilities:

1. Assists leadership peers in the 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 and Managers.

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

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

5. Provide contracting feedback recommendations based on identified network gaps and feedback from CMS associates.

6. Participates in complaint resolution and inquiries pertaining to HCMS programs.

7. Assists in developing clinical management guidelines, policies, and strategies.

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

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

10. Ensures program deliverables by monitoring established goals and implementing improvement strategies accordingly.

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

12. Ensures compliance with state reporting on healthcare management activities for accuracy.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:
- Bachelors Degree in related Health/Nursing field

Preferred:
- Master’s Degree in related Health/Nursing field

Years and Type of Experience Required:

Required:
- Minimum of seven years clinical work experience, with at least three years of leadership/management experience.

Certifications or Licensures

Required:
- RN,LCSW, or LPC

Preferred:
- Certified Case Manager

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: 2-20

Budgetary $ Responsibility: As assigned

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.

CB1

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Director-Health-Care-Mgmt-Svcs-Utilization-Management-Job-NY/2442190/244219024421902013-07-18AmerigroupNursingfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-23107 # Positions 2
Location US-CA-Fresno
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 6/13/2013
Additional Locations ..

More information about this job:
Summary:

The Coordinator Quality Management RN – Plan is responsible for developing, coordinating, implementing, and evaluating the continuous quality improvement activities for assigned populations(s) according to the established Quality management program. In collaboration with and under the direction of either Plan or Corporate Quality leadership, this position will assist in defining opportunities for improvement and collaborate with various internal and external participants to improve member experience, satisfaction, and sustainable outcomes. This position will also provide education in the area of quality improvement to departments, providers, and the community and assist in ensuring compliance with regulatory and accrediting organizations.

Responsibilities:

1. Design and implement quality improvement studies including selection of valid and reliable indicators, coordination of monitoring and evaluation activities, and medical record reviews.

2. Analyze data and prepare concise, accurate and meaningful quality management reports in accordance with QM principles.

3. Actively collaborate with Plan and/or Corporate teams to improve sustainable member outcomes.

4. Coordinate plan level resolution of member complaints/grievances in assigned population.

5. Educate providers and other organizational departments in the improvement of member outcomes and satisfaction for assigned population(s).

6. Assist in the preparation of information for RFIs, RFPS, and other QM related meetings and initiatives.

7. Conduct audits for all nationally delegated vendors and provider office visits to facilitate ongoing education and improvement for assigned populations.

8. Participate in provider office clinic days, health fairs, and community events to ensure maximum member benefit, improved data collection, and display a clinical presence.

9. Complete all other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associate’s degree in nursing or related field.

Preferred:
- Bachelor’s degree (or equivalent) in nursing or related field.

Years and Type of Experience Required:

Required:
- 2 years experience in quality improvement, risk management and/or utilization review in a managed care setting.

Preferred:
- Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting.

Certifications or Licensures

Required:
- Current professional RN license.

Preferred:
- CPHQ

Language Skills

Required:
- English

Preferred:
- Bilingual capabilities (Spanish or other)

Technical Capabilities
- Proficiency in company supported software (i.e., Excel, Outlook, Word)

Behavioral Competencies
- Good verbal and interpersonal skills.
- Good telephonic skills.
- Professional demeanor.
- Appreciation of cultural diversity and sensitivity toward populations served.
- Organizational skills and ability to multi-task.

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.
- Must be able to travel independently as needed and adhere to Amerigroup travel policies and procedures.

ermHO
]]>http://www.amerigroup-jobs.com/job/Fresno-Coordinator-Quality-MgtRN-Plan-Job-CA-93650/2662602/266260226626022013-07-18AmerigroupNursingfull-timeUSDstarting0BSFresno, CA, US
Job ID 2013-23113 # Positions 2
Location US-CA-Fresno
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 6/14/2013
Additional Locations ..

More information about this job:
Summary:

The Outreach Associate is responsible for providing support for clinical quality initiatives, regulatory/contractual requirements, and outreach activities to improve member experience and outcomes. Support may include telephonic, written, and/or face-to-face interactions with members and providers of an assigned population(s). This position may also provide assistance in the areas of member education classes, health promotion initiatives and data collection and recording.

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.

3. Conduct telephonic outreach and/or home visits to facilitate preventive screenings and provide education to members utilizing approved resources and materials.

4. Collect member encounter data and medical records, reviewing for completeness, and document member participation of activities as appropriate.

5. Assist members in making appointments with his/her Primary Care Physician (PCP) and/or Specialist as indicated.

6. Ensure members have seen their PCP and completed, or are in process of completing, their treatment plan or preventive care services as advised.

7. Assist members in identifying community resources, obtaining information related to classes and programs, and provide support for identified learning needs for the required level of care.

8. Promote and support a professional relationship with providers and community resources by participating in community education events, health fairs, and clinic days as needed.

9. Refer issues and concerns about members to the appropriate plan or corporate leader.

10. Performs all other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High school diploma or equivalent.

Preferred:
- College degree or equivalent.

Years and Type of Experience Required:

Required:
- One year experience in healthcare or managed care industry.
- Some understanding of medical terminology.

Preferred:
- Experience in a health related service such as community outreach worker, home health aide, etc.

Certifications or Licensures

Required:
- Valid Driver’s License

Language Skills

Required:
- English

Preferred:
- Bilingual capabilities in Spanish or other.

Technical Competencies
- Proficiency in company supported software (i.e., Excel, Outlook, Word).

Behavioral Competencies
- Good verbal and interpersonal skills.
- Good telephonic skills.
- Professional demeanor.
- Appreciation of cultural diversity and sensitivity toward populations served.
- Organizational skills and ability to multi-task.

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.
- Must be able to travel independently as needed and adhere to Amerigroup travel policies and procedures.

For NY Plan Outreach only:
- 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).

ermHO
]]>http://www.amerigroup-jobs.com/job/Fresno-Outreach-Assoc-Job-CA-93650/2665938/266593826659382013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSFresno, CA, US
Job ID 2012-21327 # Positions 1
Location US-TN-Nashville
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 11/29/2012
Additional Locations ..

More information about this job:
Summary:

Responsible for conducting telephonic or face-to-face assessments for the identification, evaluation, coordination and management of Members’ needs, including physical health, behavioral health, social services and long term services and supports; develops the Member’s Individualized Service Plan to address those needs. Establishes relationships with referral sources and community resources, while maintaining strict member confidentiality and complying with all HIPAA requirements.

Responsibilities:

1. Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team

2. Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members’ health care needs while optimizing efficiency and quality outcomes.

3. Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member’s PCP or treating physician and specialists in the development of an Individual Service Plan.

4. Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.

5. Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member’s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.

6. Reviews benefit options, acquire data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.

7. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required: (as appropriate, based upon state contract licensure requirements).
- Nursing Diploma or Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role.

Preferred:
- Experience in home health, health care, discharge planning, behavioral health, collaborating with nursing facilities, community resources, and/or other home and community-based agencies.
- Experience working with Medicare, Medicaid, and managed care programs.

Certifications or Licensures

Required:
- Active licensed RN, LPN/LVN, LSW or LCSW, LMSW, as required by state contract.
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.

Language Skills

Required:
- English

Preferred:
- Bilingual (ability to read, write, and speak)

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with case or utilization management data systems.
- Solid understanding of the healthcare industry and government insurance programs.
- Seeks opportunities to acquire new knowledge and skills.
- Accepts feedback openly, without becoming defensive.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Follows up with customers to ensure problems are solved.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Nashville-Care-Coordinator-Dickson%2C-Williamson-Job-TN-37201/2299575/229957522995752013-07-18AmerigroupNursingfull-timeUSDstarting0BSNashville, TN, USKeywords:
Bilingual Spanish, Call Center, Customer Service, CSR, Representative, Healthcare, Managed Care, Agent

Summary:

The Nashville Contact Center, with operations in Nashville, TN, delivers a variety of support resources to members of Amerigroup's Health Plans.

Associates are focused on understanding and meeting the needs of our customers by connecting with the mission and vision in their daily work activity. While working with our customers over the phone, Customer Care associates use their analytical skills to identify issues and proactively engage to solve problems during the call. While anticipating the needs of our customers, Customer Care associates demonstrate good listening skills, strong verbal and written communication skills to help influence our customers resulting in an amazing customer experience.

If you are looking for a way to make a difference in the lives of others by offering a little help to those in need, you are invited to further explore employment opportunities at Amerigroup.

Responsible for responding to either inbound inquiries or outreach calls from/to potential and existing AMERIGROUP members and providers. Responsibilities include providing accurate information/education/resolution about eligibility status, benefit coverage, provider network, credentialing status, authorization/referral status, demographic changes and all other non-claim issues.

We are recruiting for training classes to start in the Summer of 2013. We will contact candidates when the start date is set.

Responsibilities:
1. Function as an information source through telephonic assistance to members, providers, billing agencies, and various company/department staff.
2. Provide pleasant customer experience through superior customer service methods, problem solving and real-time issue resolution.
3. Interact with provider community and various departments to resolve issues involving the membership and credentialing status.
4. Explain benefits, eligibility status, enrollment processing procedures and status of authorizations and referrals to callers.
5. Assist with activities to ensure membership’s continuity of care.
6. Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls), complete health assessments for plan case management (Early Case Findings and Healthy Beginnings) and conduct membership surveys.
7. Process complaints, following established guidelines.
8. Maintain knowledge of state guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance.
9. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education
Required:
• High school diploma or GED
Preferred:
• Some completed college courses or degree

Years and Type of Experience
Required:
• Two years of experience in customer service or call center environment
Preferred:
• Managed care experience

Certifications or Licensures
Required:
• N/A

Language Skills
Required:
• English
Preferred:
• Other languages as determined by business need: SPANISH.

Technical Competencies

Computer Hardware, Software, and Applications/ Office Equipment-Basic
• Ability to use software and hardware of a computer to complete certain simple tasks.
• Ability to use standard office equipment such as telephone, fax machine and copy machine.
• Working knowledge in a windows environment to include navigation skills using a mouse and keyboard and use of the Internet.
• Ability to review and draft correspondence in email system and word processing systems.
• Ability to use spreadsheets to review, organize and edit data.

Communication Skills: Verbal, Written and Call Handling-Basic
• Ability to use proper language, grammar and style in the preparation of verbal and written messages to convey a clear, concise, friendly and appropriate message to business partners and customers.
• Demonstrates skills to properly handle a telephone inquiry into the contact center. Properly greet the customer and provide information based on purpose for the call and script requirements.

Heath Care Industry Terminology
• Ability to understand basic health care industry terms, e.g. managed care, primary care physician, explanation of benefits, etc.

Read, Interpret and Apply Information
• Ability to read and comprehend the information and provide an explanation to the business partner or customer that is accurate and appropriate.
• Ability to research information using available resources.

Behavioral Competencies

Strategic Leadership
Be Strategic

• Demonstrates understanding of the organization's mission and strategies.
• Works to clarify and understand the broader purpose and mission of own work.
• Integrates and balances big-picture concerns with day-to-day activities.
• Generates innovative ideas and solutions to problems.
• Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions

• Approaches problems with curiosity and open-mindedness.
• Collects sufficient information to understand problems and issues.
• Analyzes problems and issues from different points of view.
• Applies accurate logic and common sense in making decisions

People Leadership
Develop/Support Organizational Talent

• Relates to people in an open, friendly, and accepting manner.
• Treats others with respect.
• Listens carefully and attentively to others’ opinions and ideas.
• Maintains positive relationships even under difficult or heated circumstances.
• Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration

• Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
• Appropriately involves others in decisions and plans that affect them.
• Provides honest, helpful feedback to others on their performance.
• Shares own experience and expertise with others.

Results Leadership
Show Drive and Initiative

• Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
• Maintains a consistent, high level of productivity.
• Takes personal responsibility to make decisions and take action.
• Does not easily give up in the face of unexpected obstacles.
• Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution

• Juggles many priorities and competing demands for one's time.
• Acts resourcefully to ensure that work is completed within specified time and quality parameters.
• Removes obstacles in order to move the work forward and/or get efforts back on track.
• Surfaces problems and issues before projects get derailed.

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 travel as needed and adhere to Amerigroup travel policies and procedures. CB1
]]>http://www.amerigroup-jobs.com/job/Nashville-Bilingual-Customer-Care-Representative-TN-37201/2373065/237306523730652013-07-18AmerigroupCall Centerfull-timeUSDstarting0BSNashville, TN, US
Job ID 2013-22056 # Positions 1
Location US-TN-Nashville
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 2/19/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

2. Predicts and plans for patient’s needs from pre-admission, through acute and sub acute 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. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

7. 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.

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

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of 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.

Certifications or Licensures

Required:
- RN
- Must possess a valid driver’s license and access to a motor vehicle.

Preferred:
- Certified Professional Healthcare Management

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Nashville-Utilization-Manager-RN-Job-TN-37201/2437130/243713024371302013-07-18AmerigroupNursingfull-timeUSDstarting0BSNashville, TN, US
Job ID 2013-22066 # Positions 1
Location US-TN-Nashville
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/6/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

2. Predicts and plans for patient’s needs from pre-admission, through acute and sub acute 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. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

7. 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.

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

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of 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.

Certifications or Licensures

Required:
- RN
- Must possess a valid driver’s license and access to a motor vehicle.

Preferred:
- Certified Professional Healthcare Management

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Nashville-Utilization-Manager-RN-Job-TN-37201/2439652/243965224396522013-07-18AmerigroupNursingfull-timeUSDstarting0BSNashville, TN, US
Job ID 2013-22092 # Positions 1
Location US-LA-Metairie
US-LA-Baton Rouge
Search Category Provider Relations
Type Regular Full-Time (30+ hours) Posted Date 2/25/2013
Additional Locations US-LA-Baton Rouge

More information about this 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.

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.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- College degree.

Preferred:
- Advanced degree.

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

Specific Technical Skills

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.

Certifications or Licensure

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

Other:

Required:
- 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.

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.

ermSM
]]>http://www.amerigroup-jobs.com/job/Metairie-VP-Provider-Relations-Job-LA-70001/2447009/244700924470092013-07-18AmerigroupProvider Relationsfull-timeUSDstarting0BSMetairie, LA, US
Job ID 2013-22896 # Positions 1
Location US-KS-Overland Park
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/17/2013
Additional Locations ..

More information about this job:
Summary:

Manages Plan Operations support team in one or more functional areas to include, but not limited to claims operations, provider operations, reimbursements, regulatory, complaints, credentialing and other operational areas.

Responsibilities:

1. Manages and resolve operational issues through functionally specific processes and systems. Manages and resolves issues with corporate business units including, but not limited to, claims, business solutions, configuration, call center, appeals unit, cost containment, credentialing and other functional areas as assigned. Identifies and monitor trends, and develops and implements resolution plans.

2. Prioritize projects and issues, based on Plan need.

3. Oversee the completion and accuracy of various databases.

4. Oversee provider training relating to provider portal and claims submission.

5. Manages team performance, career progression, training and development and day to day performance objectives and productivity.

6. Develop and implement tools for monitoring and evaluating performance objectives and compliance.

7. Participate as a management team member in the department and at the Plan level.

8. Facilitates Plan requirements with Corporate initiatives; promote Plan concerns and enhance communications between respective business owners.

9. Partners and supports leadership across the health plan on assigned projects ensuring company goals and initiatives are met.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Four-year college degree/ Bachelor’s Degree or equivalent experience.

Years and Type of Experience Required:

Required:
- Minimum 5 years related work experience with at least 1 year leadership or supervisory experience, or
- Successful completion of Amerigroup Leadership Development Program in lieu of years of experience.

Years and Type of Experience

Preferred:
- Experience in managed care operations.

Specific Technical Skills

Required:
- Proficiency with MS Office, Word, & Excel.
- Detailed oriented.
- Good problem solving skills.
- Good organizational and project management skills.
- Strong communication skills, both written & verbal.

Specific Technical Skills

Preferred:
- Familiarity with ICD-9 and CPT coding.
- Knowledge of provider reimbursement methodologies, claims processing, billing practices and fee schedules.
- Knowledge of credentialing and recredentialing requirements.
- Knowledge of managed health care especially government funded programs.
- Clinical experience.

SCOPE INFORMATION

# Direct Reports: 2-10

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Overland-Park-Mgr-Health-Plan-Operations-Job-KS-66062/2604272/260427226042722013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSOverland Park, KS, US
Job ID 2013-22897 # Positions 1
Location US-KS-Overland Park
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/17/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective care management, utilization of health, mental health, and substance abuse services.

Responsibilities:

1. Manages and oversees teams responsible for various HCMS functions including utilization management, case finding and coordinating those cases that involve co-morbid conditions and need to be part of the case management/disease management track.

2. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.

3. Works with providers to establish short and long term goals that meet the member’s need, functional abilities and referral sources requirements.

4. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.

5. Coordinates the identifications of members with potential for high risk complications; assesses members’ present level of physical/mental impairment utilizing defined criteria and methodology.

6. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.

7. Review benefit systems and cost benefit analysis.

8. Evaluates the member against level of care criteria.

9. Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma or Associate’s Degree in related Health/Nursing/Social Work field.

Preferred:
- Bachelor’s Degree in related Health/Nursing/Social Work field or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of five years experience in health Care Management and at least one year of leadership/management experience.

Certifications or Licensures

Required:
- RN, PA, LSW, MSW, LPC, LCSW LMHC, or LPN/LVN
- Behavioral Health may also have LMSP in addition to any of the above.

Preferred:
- Certified Case Manager or Certified Utilization Review Professional.

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
- Strong communication skills, both written and verbal; articulate, persuasive & Influential; systematic and timely.
- Demonstrate project management experience in organizing, planning and executing large-scale projects from conception through implementation.
- Experience in leading and developing people.

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: N/A

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.

CB:1

ermHO
]]>http://www.amerigroup-jobs.com/job/Overland-Park-Mgr-Health-Care-Mgmnt-Services-Utilization-Review-Inpatient-Job-KS-66062/2604274/260427426042742013-07-18AmerigroupNursingfull-timeUSDstarting0BSOverland Park, KS, US
Job ID 2013-22918 # Positions 1
Location US-KS-Overland Park
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 5/21/2013
Additional Locations ..

More information about this job:
Summary:

This position will telecommute from the Southeast Corner of Kansas.

Manages and oversees team responsible for coordination of a comprehensive health care program in which members’ needs are identified, including physical health, behavioral health, social services and long term service and supports (LTSS)

Responsibilities:

1. Manages and evaluates team’s performance, including preparation of team and individual metrics, and ensures adherence to departmental standards.

2. Manages resource utilization to ensure appropriate delivery of care to members, adequate coverage for all departmental tasks and job responsibilities; monitors telephone queue to ensure adequate coverage while incorporating QA measures and providing appropriate feedback and counseling

3. Provides guidance, feedback and training to team members facilitating the understanding of regulatory and compliance requirements.

4. Coordinates service delivery to include member assessment of physical and psychological factors.

5. May complete member Assessments; assesses members’ present level of physical/mental impairment utilizing defined criteria and methodology, coordinates the identifications of members with potential for high risk complications.

6. Participates in various cross-functional workgroups created to maintain / develop program, including developing agenda items, conducting meetings, and publishing accurate minutes to record workgroup activities / decisions.

7. Evaluates current processes of all clinical support functions; determines and recommends changes for increased efficiencies and improved outcomes.

8. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in related discipline Years and Type of Experience Required:

Required:
- Minimum of 5+ years’ relevant work experience and at least 1 year of leadership/management experience.
- Leadership Development Program in lieu of years of experience.

Preferred:
- Experience in a managed care setting with direct experience in service delivery coordination, discharge planning, or behavioral health.
- Experience working in the community with community agencies.

Certifications or Licensures

Required:
- N/A

Preferred:
- RN, LSW, LPN/LVN

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
- Analyze, incorporates and applies new information and concepts.
- Makes timely decisions on problems/issues requiring immediate attention.

SCOPE INFORMATION

# Direct Reports: 4-15

# Indirect Reports: 0

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.

CB:1

ermHO
]]>http://www.amerigroup-jobs.com/job/Overland-Park-Mgr-LTSS-Southeast-Region-Kansas-%28Telecommuter%29-Job-KS-66062/2609152/260915226091522013-07-18AmerigroupCase Managementfull-timeUSDstarting0BSOverland Park, KS, US
Job ID 2013-23103 # Positions 1
Location US-KS-Overland Park
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 6/13/2013
Additional Locations ..

More information about this job:
Summary:

This position is a telecommuting position located in the Sedgwick County/or close by county area of Kansas. You must reside in this area and cover the distance in your personal vehicle in these areas.

Responsible for conducting telephonic or face-to-face assessments for the identification, evaluation, coordination and management of Members’ needs, including physical health, behavioral health, social services and long term services and supports; develops the Member’s Individualized Service Plan to address those needs. Establishes relationships with referral sources and community resources, while maintaining strict member confidentiality and complying with all HIPAA requirements.

Responsibilities:

1. Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team.

2. Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members’ health care needs while optimizing efficiency and quality outcomes.

3. Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member’s PCP or treating physician and specialists in the development of an Individual Service Plan.

4. Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.

5. Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member’s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.

6. Reviews benefit options, acquires data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors degree from an accredited college or university in Nursing, Social Work, Counseling, Special Education, Sociology, Psychology, Gerontology, or a closely related field, State Waiver (NM), or a minimum of six years of experience working for State agencies directly or by contract.
- Bachelors Degree in an unrelated field and at least two years of geriatric experience

Preferred:
- Masters degree from an accredited college or university in Nursing, Social Work, Counseling, Special Education, Sociology, Psychology, Gerontology, or a closely related field.

Years and Type of Experience Required:

Required:
- Minimum of two years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role.

Preferred:
- Experience in home health, health care, discharge planning, behavioral health, collaborating with nursing facilities, community resources, and/or other home and community-based agencies.
- Experience working with Medicare, Medicaid, and managed care programs.

Certifications or Licensures

Required:
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.
- Additional state mandated certification, where appropriate.

Language Skills

Required:
- English

Preferred:
- Bilingual (ability to read, write, and speak).

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with case or utilization management data systems.
- Solid understanding of the healthcare industry and government insurance programs.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Overland-Park-LTSS-Service-Coordinator-South-Central-Sedgwick-County-Telecommuting-Job-KS-66062/2662604/266260426626042013-07-18AmerigroupCase Managementfull-timeUSDstarting0BSOverland Park, KS, US
Job ID 2013-23102 # Positions 1
Location US-KS-Overland Park
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 6/13/2013
Additional Locations ..

More information about this job:
Summary:

This position is a telecommuting position located in the Sedgwick County/or close by county area of Kansas. You must reside in this area and cover the distance in your personal vehicle in these areas.

Responsible for conducting telephonic or face-to-face assessments for the identification, evaluation, coordination and management of Members’ needs, including physical health, behavioral health, social services and long term services and supports; develops the Member’s Individualized Service Plan to address those needs. Establishes relationships with referral sources and community resources, while maintaining strict member confidentiality and complying with all HIPAA requirements.

Responsibilities:

1. Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team.

2. Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members’ health care needs while optimizing efficiency and quality outcomes.

3. Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member’s PCP or treating physician and specialists in the development of an Individual Service Plan.

4. Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.

5. Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member’s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.

6. Reviews benefit options, acquires data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors degree from an accredited college or university in Nursing, Social Work, Counseling, Special Education, Sociology, Psychology, Gerontology, or a closely related field, State Waiver (NM), or a minimum of six years of experience working for State agencies directly or by contract.
- Bachelors Degree in an unrelated field and at least two years of geriatric experience

Preferred:
- Masters degree from an accredited college or university in Nursing, Social Work, Counseling, Special Education, Sociology, Psychology, Gerontology, or a closely related field.

Years and Type of Experience Required:

Required:
- Minimum of two years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role.

Preferred:
- Experience in home health, health care, discharge planning, behavioral health, collaborating with nursing facilities, community resources, and/or other home and community-based agencies.
- Experience working with Medicare, Medicaid, and managed care programs.

Certifications or Licensures

Required:
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.
- Additional state mandated certification, where appropriate.

Language Skills

Required:
- English

Preferred:
- Bilingual (ability to read, write, and speak).

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with case or utilization management data systems.
- Solid understanding of the healthcare industry and government insurance programs.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Overland-Park-LTSS-Service-Coordinator-South-Central-Sedgwick-County-Telecommuting-Job-KS-66062/2662605/266260526626052013-07-18AmerigroupCase Managementfull-timeUSDstarting0BSOverland Park, KS, US
Job ID 2013-22985 # Positions 1
Location US-KS-Overland Park
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/31/2013
Additional Locations ..

More information about this job:
Summary:

***** This position will be located in Wichita- Telecommuter position*****

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.

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.

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

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

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

11. Performs other duties and special projects as assigned.

Qualifications:

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.

Certifications or Licensures

Required:
- Valid Driver’s License

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.

ermCS
]]>http://www.amerigroup-jobs.com/job/Overland-Park-Provider-Relations-Representative-II-%28Location-Wichita%2C-KS-Telecommuter%29-Job-KS-66062/2633192/263319226331922013-07-18AmerigroupCustomer Servicefull-timeUSDstarting0BSOverland Park, KS, US
Job ID 2013-23086 # Positions 1
Location US-NV-Las Vegas
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 6/11/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Licensed RN Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

2. Predicts and plans for patient’s needs from pre-admission, through acute and sub acute 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. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

7. 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.

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

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of 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.

Certifications or Licensures

Required:
- RN
- Must possess a valid driver’s license and access to a motor vehicle.

Preferred:
- Certified Professional Healthcare Management

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Las-Vegas-Utilization-Manager-RN-Job-NV-89044/2656535/265653526565352013-07-18AmerigroupNursingfull-timeUSDstarting0BSLas Vegas, NV, US
Job ID 2013-23096 # Positions 1
Location US-NV-Las Vegas
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 6/12/2013
Additional Locations ..

More information about this job:
Summary:

The Coordinator Quality Management RN – Plan is responsible for developing, coordinating, implementing, and evaluating the continuous quality improvement activities for assigned populations(s) according to the established Quality management program. In collaboration with and under the direction of either Plan or Corporate Quality leadership, this position will assist in defining opportunities for improvement and collaborate with various internal and external participants to improve member experience, satisfaction, and sustainable outcomes. This position will also provide education in the area of quality improvement to departments, providers, and the community and assist in ensuring compliance with regulatory and accrediting organizations.

Responsibilities:

1. Design and implement quality improvement studies including selection of valid and reliable indicators, coordination of monitoring and evaluation activities, and medical record reviews.

2. Analyze data and prepare concise, accurate and meaningful quality management reports in accordance with QM principles.

3. Actively collaborate with Plan and/or Corporate teams to improve sustainable member outcomes.

4. Coordinate plan level resolution of member complaints/grievances in assigned population.

5. Educate providers and other organizational departments in the improvement of member outcomes and satisfaction for assigned population(s).

6. Assist in the preparation of information for RFIs, RFPS, and other QM related meetings and initiatives.

7. Conduct audits for all nationally delegated vendors and provider office visits to facilitate ongoing education and improvement for assigned populations.

8. Participate in provider office clinic days, health fairs, and community events to ensure maximum member benefit, improved data collection, and display a clinical presence.

9. Complete all other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associate’s degree in nursing or related field.

Preferred:
- Bachelor’s degree (or equivalent) in nursing or related field.

Years and Type of Experience Required:

Required:
- 2 years experience in quality improvement, risk management and/or utilization review in a managed care setting.

Preferred:
- Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting.

Certifications or Licensures

Required:
- Current professional RN license.

Preferred:
- CPHQ

Language Skills

Required:
- English

Preferred:
- Bilingual capabilities (Spanish or other)

Technical Capabilities
- Proficiency in company supported software (i.e., Excel, Outlook, Word)

Behavioral Competencies
- Good verbal and interpersonal skills.
- Good telephonic skills.
- Professional demeanor.
- Appreciation of cultural diversity and sensitivity toward populations served.
- Organizational skills and ability to multi-task.

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.
- Must be able to travel independently as needed and adhere to Amerigroup travel policies and procedures.

ermHO
]]>http://www.amerigroup-jobs.com/job/Las-Vegas-Coordinator-Quality-MgtRN-Plan-Job-NV-89044/2659659/265965926596592013-07-18AmerigroupNursingfull-timeUSDstarting0BSLas Vegas, NV, US
Job ID 2013-22128 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/26/2013
Additional Locations ..

More information about this job:
Summary:

The Coordinator Quality Management RN – Plan is responsible for developing, coordinating, implementing, and evaluating the continuous quality improvement activities for assigned populations(s) according to the established Quality management program. In collaboration with and under the direction of either Plan or Corporate Quality leadership, this position will assist in defining opportunities for improvement and collaborate with various internal and external participants to improve member experience, satisfaction, and sustainable outcomes. This position will also provide education in the area of quality improvement to departments, providers, and the community and assist in ensuring compliance with regulatory and accrediting organizations.

Responsibilities:

1. Design and implement quality improvement studies including selection of valid and reliable indicators, coordination of monitoring and evaluation activities, and medical record reviews.

2. Analyze data and prepare concise, accurate and meaningful quality management reports in accordance with QM principles.

3. Actively collaborate with Plan and/or Corporate teams to improve sustainable member outcomes.

4. Coordinate plan level resolution of member complaints/grievances in assigned population.

5. Educate providers and other organizational departments in the improvement of member outcomes and satisfaction for assigned population(s).

6. Assist in the preparation of information for RFIs, RFPS, and other QM related meetings and initiatives.

7. Conduct audits for all nationally delegated vendors and provider office visits to facilitate ongoing education and improvement for assigned populations.

8. Participate in provider office clinic days, health fairs, and community events to ensure maximum member benefit, improved data collection, and display a clinical presence.

9. Complete all other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associate’s degree in nursing or related field.

Preferred:
- Bachelor’s degree (or equivalent) in nursing or related field.

Years and Type of Experience Required:

Required:
- 2 years experience in quality improvement, risk management and/or utilization review in a managed care setting.

Preferred:
- Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting.

Certifications or Licensures

Required:
- Current professional RN license.

Preferred:
- CPHQ

Language Skills

Required:
- English

Preferred:
- Bilingual capabilities (Spanish or other)

Technical Capabilities
- Proficiency in company supported software (i.e., Excel, Outlook, Word)

Behavioral Competencies
- Good verbal and interpersonal skills.
- Good telephonic skills.
- Professional demeanor.
- Appreciation of cultural diversity and sensitivity toward populations served.
- Organizational skills and ability to multi-task.

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.
- Must be able to travel independently as needed and adhere to Amerigroup travel policies and procedures.

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Quality-RN-Fair-Hearings-Manhattan-Job-NY/2453563/245356324535632013-07-18AmerigroupNursingfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22161 # Positions 1
Location US-NY-New York
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 3/8/2013
Additional Locations ..

More information about this job:
Summary:

Performs complex research and analysis to support business operations. Determines best practices and suggests how to improve current practices. Develops recommendations to solve problems and issues related to business operations and communicates with other departments as necessary. May perform special projects upon request and oversee the work of less experienced Business Analysts. Responsible for functional area and its interrelation with other areas in the capacity of gathering requirements, performing analysis, supporting the development and testing processes of assigned functional area and incorporating the applications, data, and associated technologies for supported areas. Analyzes and reports on complex business problems to be solved with automated systems or other resources. Provide expertise in identifying, evaluating and developing procedures that are cost effective and meet user requirements. Act as a resource to users of business applications and procedures.

Responsibilities:

1. Perform detailed requirements gathering, analysis, and process and data flow diagramming for simple processes of moderate complexity, considering the relationship between processes. Identify risks and multiple solutions.

2. Evaluate and test complex new/modified programs, applications and/or operating systems to ensure adherence to operational specifications. Monitor system and business functionality and performance. Document and track product defects.

3. Coordinate problem resolution with development and/or product vendors.

4. Recommend improvements to existing procedures and business processes. Influence others to follow existing procedures.

5. Read and interpret a design document.

6. Read and interpret conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

7. Use appropriate methods to resolve moderately complex business and design issues.

8. Develop and run complex queries and reports for business analysis and trends. Perform data base updates.

9. Write, revise, and verify test plans for moderately complex systems in a software application.

10. Ensure compliance of current license and support agreements and requirements are met.

11. Manage multiple priorities at the same time.

12. Functions as a liaison for IT and the business and other cross functional resources and departments.

13. Mentor and lead less experienced BAs and functional area associates.

14. Manage project related budgets.

15. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:

Bachelor’s degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience in a Business Analyst role is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Five years experience in business analysis or functional analysis role.

Preferred:
- Health care industry experience.

Certifications or Licensures

Preferred:
- CBAP (Certified Business Analyst Professional).

Language Skills

Required:
- English

Depending on the business area for a specific position, competency in one or more of the following may be Required:

Technical Competencies
- Advanced understanding of the inter-relationship among various IT applications and systems.
- Demonstrate the ability to seek alternatives, new ideas, and/or approaches to problems.
- Advanced 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.
- Able to initiate conceptual ideas with practical applications.

Computer Skills and Office Equipment - Intermediate
- Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data. Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.

Spreadsheet Utilization and Management - Intermediate
- Proficient in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools.

Database Utilization and Database Management - Intermediate
- Proficient in database utilization including ability to conduct queries and design databases, and perform multiple table query design. Multi table. Ability to perform general data analysis. Accounts of records of a certain type.

Systems - Intermediate

Understanding of system's utilization and proficient retrieval of information and processing of the following systems:
- NetworX/Facets – build pricing based on provider contracts using Facets applications. Build benefit plans based on State regulations using Facets benefit applications.
- MACESS – contracts and claim images are stored. MACESS Workflow tool for contract life-cycle.
- Software products from Ingenix for prospective payment system (PPS) – pricing.
- Clearquest is used to track projects –knowledge and familiarity using a project inventory tracking system.

Applications/Tools

Intermediate ability to leverage avaialbe tools such as:
- TOAD, UltraEdit, Microsoft Project, Microsoft query analyzer SQL mgr, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity - Basic
- General healthcare, who are our providers (hospitals phy ofc, ancil) who are payors (insurance companies),
- High level claims process, knowledge of general industry how it works.
- More specific knowledge around reimbursement methodology, fee schedules. Per case, per diem, DRG, % of charges, those terms. HIPAA.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping DRG codes, place of service codes (POS),
- Government Programs Specific Knowledge:
- Medicare Medicaid programs, CHIP and LTC.
- Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Gather and Document Requirements

Intermediate: Ability to prepare simple to moderately-complex requirements documents.
- Ability to facilitate requirements gathering including determining the most efficient and effective way to capture the requirements, and managing kick off and subsequent status meetings. Ability to manage timelines and due dates. Ability to recognize and understand business changes that impact requirements and incorporate changes into documentation. Ability to read and re-read requirements documents multiple times while maintaining detail orientation.

Contracts

Intermediate: Ability to read a contract and understand the operational requirements the contract creates.
- Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving-Analytics
- Basic critical thinking and problem solving methods.

Project Management
- Intermediate: Skilled in running a project utilizing standard project management tools, techniques and methodology. Keeps project on task.

Testing
- Intermediate: Functions independently in the creation of simple to moderately-complex test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

SCOPE INFORMATION

# Direct Reports:

# 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.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

ermIT
]]>http://www.amerigroup-jobs.com/job/New-York-Operations-Business-Analyst-III-Job-NY/2470145/247014524701452013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-21624 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/16/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for managing members experiencing complex or catastrophic illness, high risk pregnancy, injury and/or specialty illnesses such as diabetes, HIV, transplant, behavioral health conditions, etc., to ensure cost effective and efficient utilization of health services. Conducts continuous skills assessment, planning, implementation, coordination, monitoring and evaluation.

As a Complex Case Manager you will be responsible for coordinating the care and services provided to members who have experienced a critical event or have multiple diagnoses or complications that require extensive use of resources and who need help navigating the system to facilitate appropriate delivery of care and services within plan benefits. You must have experience with assisting members/patients in accessing community based resources, providing disease specific education or any of a broad range of interventions designed to improve the quality of life and functionality of members, and to make more efficient use of available health-care and community based resources.

Responsibilities:

1. Obtains an accurate member history, conducts an assessment of biopsychosocial factors, and assesses clinical information to develop care plans including a member support system.

2. Establishes prioritized short and long term goals in collaboration with the member that meet the member’s needs and the referral source’s requirements.

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

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

5. Collaborates with the member’s PCP and specialists in the development of the plan of care to ensure that members’ physical needs are addressed; communicates care objectives to appropriate individuals/departments/referral sources.

6. Provide case management and/or disease management services to members, as identified by a health plan’s referral process.

7. May be required to conduct field visits.

8. May be required to perform service authorization duties using prescribed criteria and responsibilities as assigned and required by the Plan

9. Acts as an advocate for an individual’s health care needs.

10. Reviews benefit systems and cost benefit analysis; evaluates the quality and necessity of applicable services; identifies members that would benefit from an alternative level of care; acquires data and evaluates necessary health services for cost containment; documents effectiveness of case management services

11. Participates in Quality Improvement processes and serves on internal and external committees as required.

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of three years clinically related experience.

Preferred:
- Experience working on the community level and with community agencies.
- Experience in managed care, case management and discharge planning.

Certifications or Licensures

Required:
- Active licensed RN.
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.

Preferred:
- Certified Case Manager.

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Telephonic-Case-Manager-RN-Complex-Acute-Job-NY/2549315/254931525493152013-07-18AmerigroupNursingfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-21793 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/17/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

2. Predicts and plans for patient’s needs from pre-admission, through acute and sub acute 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. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

7. 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.

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

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of 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.

Certifications or Licensures

Required:
- RN
- Must possess a valid driver’s license and access to a motor vehicle.

Preferred:
- Certified Professional Healthcare Management

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Utilization-Manager-RN-Job-NY/2551823/255182325518232013-07-18AmerigroupNursingfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22616 # Positions 1
Location US-NY-New York
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 4/17/2013
Additional Locations ..

More information about this job:
Summary:

To develop, maintain and enhance mechanisms to track, trend, and report quality measures and compliance reports for the health plan(s). To support the continuous quality improvement process needs of the Quality Department and Risk Control and Compliance Operations through comprehensive analysis, documentation and reporting of data pertaining to company performance and compliance goals.

Responsibilities:

1. Collaborates with business data owners to develop, analyze, maintain and submit reports used to measure, monitor and manage quality of care, service, compliance and quality improvement initiatives.

2. Assists in the data analysis, development, reporting and submission of mandatory Health Plan reports to Health and Human Services and other regulators.

3. Manages and validates HEDIS data and projects; assure data integrity and reporting of rates.

4. Develops and utilizes knowledge of databases, information systems, managed care, Medicaid/CHIP population, statistical tools and analytical principles to analyze quality outcomes that support strategies for managing health plan performance.

5. Participates in quality initiatives by assisting with data analysis, project design, inter-rater reliability studies and project documentation.

6. Compiles and analyzes data including comparison of outcome measures to benchmark, identifying trends, completing barrier analysis, and assisting in the identification of activities to reach performance goal. Assures completion, accuracy and timeliness of all reports and data.

7. Performs statistical tests to determine statistical significance, confidence level, validity and reliability of outcome.

8. Supports systems to provide trended data related to member satisfaction, complaint and appeal processes, provider satisfaction, provider access and availability, and other areas required for the quality program evaluation.

9. Conduct troubleshooting with management and IT as problems in data management systems arise to promote consistency in reporting.

10. Participates in clinical focus study development, data collection, analysis and report writing.

11. Coordinates clinical focus study activities, serving as project lead, as assigned.

12. Actively participates in plan-wide or state-wide preparation for accreditation surveys and regulatory audits by creating and maintaining compliance roadmaps, as assigned.

13. Develops, maintains and standardizes reports for State quality and compliance reporting.

14. Functions as expert in QM data retrieval and reporting.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in business, science, healthcare or related field preferred. Equivalent experience considered.
- 3-5 years data analysis or statistical experience or successful completion of Amerigroup Leadership Development Program in lieu of years of experience.
- Proficient with window based environment, particularly Microsoft Excel and Access. Working knowledge of information systems including database design.
- Previous HMO/Managed Care industry experience preferred.
- Knowledge of SPSS, Minitab and SQL preferred.
- Understanding of ICD-9 and CPT coding system helpful.

Knowledge and Skills
- Excellent analytic skills, attention to detail.
- Detailed familiarity with computer systems, word processing, spreadsheet, statistical packages and other data base management software.
- Good organizational skills; the ability to handle multiple priorities simultaneously with a high quality result.
- Excellent writing skills.
- Appreciation of cultural diversity towards target population.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.

CB:1

ermHO
]]>http://www.amerigroup-jobs.com/job/Overland-Park-Sr-Quality-Data-Analyst-Kansas-Job-KS-66062/2551829/255182925518292013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22600 # Positions 2
Location US-VA-Virginia Beach
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/16/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for managing members experiencing complex Behavioral health conditions that requires case management, to ensure cost effective and efficient utilization of health services. Conducts continuous skills assessment, planning, implementation, coordination, monitoring and evaluation. Also responsible for post facility discharge management focusing on the prevention of readmissions.

Responsibilities:

1. Obtains an accurate member history, conducts an assessment of biopsychosocial factors, and assesses clinical information to develop care plans including a member support system.

2. Establishes prioritized short and long term goals in collaboration with the member that meet the member’s needs and the referral source’s requirements.

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

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

5. Collaborates with the member’s PCP and specialists in the development of the plan of care to ensure that members’ physical needs are addressed; communicates care objectives to appropriate individuals/departments/referral sources.

6. Provide case management and/or disease management services to members, as identified by a health plan’s referral process.

7. May be required to conduct field visits.

8. May be required to perform service authorization duties using prescribed criteria and responsibilities as assigned and required by the Plan

9. Acts as an advocate for an individual’s health care needs.

10. Reviews benefit systems and cost benefit analysis; evaluates the quality and necessity of applicable services; identifies members that would benefit from an alternative level of care; acquires data and evaluates necessary health services for cost containment; documents effectiveness of case management services.

11. Participates in Quality Improvement processes and serves on internal and external committees as required.

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Prefered:
- Bachelor’s or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of three years clinically related experience.

Preferred:
- Experience working on the community level and with community agencies.
- Experience in managed care, case management and discharge planning.

Certifications or Licensures

Required:
- Active licensed LSW or LCSW, LMSW, as required by state contract.
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.

Preferred:
- Certified Case Manager

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Behavioral-Health-Case-Manager-SPG-Medicare-Job-VA-23450/2549317/254931725493172013-07-18AmerigroupNursingfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-23093 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 6/14/2013
Additional Locations ..

More information about this job:
Summary:

With guidance on unusual complex problems or issues, assists in the design and maintenance of internal/external company web pages, including graphics, animations and functionality. Provides on-going analysis and monitoring of corporate web sites. Works on problems of moderate scope where analysis of situations or data requires a review of a variety of factors Work with project teams and business units on implementing web pages.

Responsibilities:

1. Building on knowledge and experience works to develop and maintain content on corporate website utilize Amerigroup web architectures and standards.

2. Participate in the review and creation of web based coding standards. Ensures that standards are followed.

3. Participate in the review and creation of web based security standards. Ensures that standards are followed.

4. Configure and maintain web servers.

5. Coordinate production changes to the web environments.

6. Interface with users, developers and others to ensure web site functionality and currency of information.

7. Aid developers in understanding web application issues, performance guidelines, infrastructure issues, and coding practices.

8. Performance tune web based applications and components for efficiency, performance, code reuse, and usability.

9. Manage current license and support agreements to ensure compliance and requirements are met for assigned contracts.

10. Perform other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree. Equivalent experience is acceptable in lieu of a degree(s).

Preferred:
- Bachelor of Science in Information System or Computer Science.

Years and Type of Experience Required:

Required:
- A minimum of 2 years of relevant work experience.

Preferred:
- Managed care / health care background.

Certifications or Licensures

Required:
- None

Language Skills

Required:
- English

Technical Competencies Computer Hardware, Software and Applications / Office Equipment - Basic
- Ability to use hardware and software of a computer to complete certain simple tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Proficiency in a windows environment. Ability to review and draft correspondence in email and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Web Development- Intermediate
- Solid knowledge of web development tools, e.g. xHTML, CSS, ASP.NET, SQL, JavaScript. Able to develop and fine-tune web-based applications and components for efficiency, performance, code reuse and usability. Basic knowledge of different web services. Able to participate in the review of existing web development and security standards. Can employ full range of common Internet technologies to solve business needs.

Project Management- Intermediate
- Ability to develop and implement basic to moderately complex project plans.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 0

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Web-Developer-II-Job-VA-23450/2665941/266594126659412013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22910 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/20/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for functional area business analysis and how the functional areas interrelate, gathering requirements, performing analysis, managing the design, configuration, development and testing processes and system changes, and understanding the applications, data, and associated technologies for supported areas. Analyzes data for studies of management and operational procedures to determine cost efficiency, corrective action and compliance with goals and objectives. Analyze highly complex business problems to be solved with automated systems and other resources. Develops and maintains positive client relationships in functioning as the liaison between the business, health plans, operational areas and Information Technology Services (ITS). Work with staff to ensure requirements will be incorporated into system design and testing. Support departmental methodologies and provide input for improvement to tools and processes. Leads cross-functional linked teams to address business or systems issues. Acts as an advocate to ensure quality and timeliness of project deliverables. Provide leadership within the team, department, and organization.

Responsibilities:

1. Perform detailed requirements gathering, analysis, design, configuration, and process and data flow diagramming for processes of high complexity. Understand and consider the relationship between processes and business policies.

2. Function as a liaison between business, health plans, operational areas, and ITS.

3. Identify risks and multiple solutions.

4. Recommend and implements improvements to existing procedures. Influence others to follow existing procedures.

5. Lead all system/application testing for implementations, conversions, upgrades and updates including individual claim and batch testing. Ensure all application updates are implemented timely.

6. Develop and adhere to existing configuration management procedures. Recommend improvements to existing procedures.

7. Read and interpret design document conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

8. Develop complex queries and reports. Perform database updates.

9. Write, revise, and verify test plans for multiple complex systems in a software application. Provide leadership and guidance to other analysts in the creation of system test plans.

10. 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.

11. Validate proposed contracts meet requirements taking into consideration financial arrangements and impacts as they apply to the budget as applicable in functional area of responsibility.

12. Make technical and functional business recommendations based on evolving technologies and evolving application trends to include infrastructure, software, database, and networks.

13. Address business challenges to improve efficiency and decision making, reduce redundancy, and ultimately enhance business results.

14. Manage multiple priorities and projects.

15. Lead and mentor functional area team members and other Business Analysts.

16. Manage project related budgets as applicable in functional area of responsibility.

17. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience in a Business or Systems Analyst role is acceptable in lieu of a degree(s).

Preferred:
- Master’s degree.

Years and Type of Experience Required:

Required:
- 8 years experience in systems analysis, or business analysis.

Preferred:
- Health Care industry experience.

Certifications or Licensures

Preferred:
- CBAP (Certified Business Analyst Professional)

Language Skills

Required:
- English

Depending on the business area for a specific position, competency in one or more of the following may be Required:

Technical Competencies

Required:
- Comprehensive knowledge of core IT applications and systems.
- Advanced knowledge and skills as a subject matter expert in one or more of the following managed care business areas: Member Enrollment, Provider Information Management, Claims Processing and Adjudication, Benefits Configuration, and/or Call Center.
- 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.
- Able to develop creative strategies and tap the creative potential of individuals and groups.
- Able to continually assess needs and implement measures to ensure customer expectations are met or exceeded.
- Able to turn problems into opportunities for change.
- Advanced proficiency with all applicable company supported software applications.
- Able to apply configuration knowledge to resolve basic to moderate business issues, identify alternatives, determine impact, and recommend optimal configuration solutions.
- Comprehensive working knowledge of managed care operational areas and managed care products in each market in which AGP operates, including current trends in the industry.
- Advanced understanding of data architecture.
- Advanced understanding of infrastructure associated with supported applications.
- Extensive knowledge of analysis techniques and standards and set analysis standards.
- Comprehensive understanding of how each department/health plan relates to the organization as a whole.

Computer Skills and Office Equipment - Advanced
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data. Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.

Spreadsheet Utilization and Management - Advanced
- Expert level of proficiency in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools. Ability to create spreadsheets in spreadsheets.

Database Utilization and Database Management - Intermediate
- Proficient in database utilization including ability to conduct queries and design databases, and perform multiple table query design. Multi table. Ability to perform general data analysis. Accounts of records of a certain type.

Systems - Expert
- Understands systems development lifecycle. Understanding of system's utilization and considered a systems SME for the following systems:
- NetworX/Facets – build pricing based on provider contracts using Facets applications. Build benefit plans based on State regulations using Facets benefit applications.
- MACESS – contracts and claim images are stored. MACESS Workflow tool for contract life-cycle.
- Software products from Ingenix for prospective payment system (PPS) – pricing.
- Clearquest is used to track projects –knowledge and familiarity using a project inventory tracking system.

Applications/Tools - Intermediate
- Ability to leverage available tools such as:
- TOAD, UltraEdit, Microsoft Project, Microsoft query analyzer SQL mgr, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity - Basic
- General healthcare, who are our providers (hospitals phy ofc, ancil) who are payors (insurance companies),
- High level claims process, knowledge of general industry how it works.
- More specific knowledge around reimbursement methodology, fee schedules. Per case, per diem, DRG, % of charges, those terms. HIPAA.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping DRG codes, place of service codes (POS).

Government Programs Specific Knowledge
- Medicare Medicaid programs, CHIP and LTC.
- Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Gather and Document Requirements - Expert
- Mentors others.
- Viewed as a SME.
- Ability to prepare the most complex requirements documents.
- Ability to facilitate requirements gathering including determining the most efficient and effective way to capture the requirements, and managing kick off and subsequent status meetings.
- Ability to manage timelines and due dates. Ability to recognize and understand business changes that impact requirements and incorporate changes into documentation.
- Ability to read and re-read requirements documents multiple times while maintaining detail orientation.

Contracts - Intermediate
- Ability to read a contract and understand the operational requirements the contract creates. Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving-Analytics - Advanced
- Ability to understand moderate to complex business process flows (complex, corporate or enterprise-wide).
- Ability to thoroughly understand, analyze and synthesize data, including relationships of data, e.g.
- Cause/effect. Ability to conduct business analysis, requirements gathering, process analysis and gap analysis.

Project Management - Advanced
- Skilled in running multiple projects utilizing standard project management tools, techniques and methodology. Keeps projects on task.

Testing - Advanced
- Advises and mentors others. Functions independently in the creation of moderate to complex test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

SCOPE INFORMATION

# Direct Reports:

# Indirect Reports: 0 – 15

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.
- Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Business-Analyst-Principal-I-Job-VA-23450/2606766/260676626067662013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22966 # Positions 1
Location US-VA-Virginia Beach
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/29/2013
Additional Locations ..

More information about this job:
Summary:

In accordance with the Project Management Body of Knowledge (PMBOK) and PMI standards, manages a small project or phase(s) of a larger project. Responsible for all aspect of the project. Responsible for familiarity with system scope and project objectives, as well as the role and function of each project team member or functional area, to effectively manage the activities of the team.

Responsibilities:

1. Manage changes to the project scope, project schedule, and project costs using appropriate verification techniques in order to keep the project plan accurate, updated, reflective of authorized project changes as defined in the change management plan, and facilitate customer acceptance.

2. Assists senior Project Managers and business leaders to ensure resource availability, workload and performance as well as to drive project vision through effective risk management and manage changes through a defined change management system.

3. Assist in the mentoring of less project coordinators and business analysts.

4. Communicate and ensure a common understanding by setting expectations in accordance with the Project Plan, in order to align the stakeholders and team members.

5. Measure project performance using appropriate tools and techniques in order to monitor the progress of the project, identify and quantify any variances, perform any required corrective actions, and communicate to all stakeholders.

6. Execute the tasks as defined in the project plan in order to achieve the project goals.

7. Identify key project team members by defining roles and responsibilities to create a project organization structure in order to develop the communication plan.

8. Implement the approved actions and workarounds required to mitigate project risk events in order to minimize the impact of the risks on the project.

9. Record detailed customer requirements, constraints, and assumptions with stakeholders in order to establish the project deliverables, using requirement-gathering techniques such as planning sessions, brainstorming, focus groups and the project charter.

10. Improve project and functional team performance by building team cohesiveness, leading, mentoring, training, and motivating in order to facilitate cooperation, and ensure project efficiency.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- HS Diploma

Preferred:
- Bachelors Degree or equivalent.

Years and Type of Experience Required:

Required:
- 1- 3 years Project Management/Project Coordination.

Experience

Preferred:
- Health care insurance industry experience.
- MS Project, Outlook, PowerPoint and Visio experience.
- Familiarity with data collection and analysis techniques.
- Survey tools experience, e.g. Survey Monkey.

Certifications or Licensures

Preferred:
- PMI CAPM (Certified Associate in Project Management).

Language Skills

Required:
- English

Technical Competencies

Project Management - Intermediate
- Ability to independently lead small to medium projects or one large project in accordance with Project Management Body of Knowledge (PMBOK) and Project Management Institute (PMI) standards. Solid understanding of process improvement and project management including tools and techniques, critical path method, program evaluation and review technique, resource balancing and cost estimating. Ability to clarify and interpret the relationships between a system and its component parts.

Industry Knowledge & Familiarity - Intermediate
- Solid understanding of the healthcare industry and government insurance programs, e.g. Medicare, Medicaid, CHIP and LTC. Computer Skills and Office Equipment - Intermediate
- Ability to use software and hardware of a computer, e.g. Outlook, PowerPoint, etc., to complete certain moderately complex tasks. Able to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key. Use of internet, familiarity with SharePoint sites. Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to solve problems. Ability to create and manipulate spreadsheets (i.e., data entry and format cells).

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Makes Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

SCOPE INFORMATION

# Direct Reports: 0

Project Budget Range: $0 - $500,000

Project Team Size: 1-9

Project Duration: 1 – 11 months

Project Timeline: Moderately Aggressive

Project Risk: Medium

# of System Interfaces: 1

#of Geographical Regions: 1 – 2

# of Functional Disciplines/Stakeholders: 1-5

# of Sub-Projects: 0

Level of Innovation / Means to Achieve Goals: Existing/Proven Project Scope Definition: Well Defined

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Project-Manager-I-Health-Care-Economics-Job-VA-23450/2627211/262721126272112013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22967 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 6/10/2013
Additional Locations ..

More information about this job:
Summary:

Functions as a recognized expert; leads the identification, improvement planning and implementation of business process improvements and work to advance Amerigroup’s strategic imperatives. Leads process improvement initiatives and is responsible for improving Amerigroup business processes through application and disciplined use of best practices, process metrics, process mapping, incremental process improvement methods such as Six Sigma and Work Out™ and also lead full process re-engineering initiatives. Leads the discussion of process alternatives in order to arrive at best practices. Coordinates the development of process documentation, process staffing models and education for identified projects. Builds strong working relationships with Corporate and Plan senior management and support areas to assist in meeting the goals of the organization. Responsible for identifying and prioritizing opportunities for improvement in the areas of efficiency and effectiveness. Focus is on process analysis and re-engineering, with an understanding of technical problems and solutions as they relate to the current and future business environment. Involved in developing, modifying and executing company policies that affect immediate operations and may also have company-wide effect.

The incumbent will be responsible for various projects and initiatives such as but not limited to:
- Overseeing the Budget, and partnering with Finance
- Assisting the Medicaid CIO in providing direction to area/management team
- Enable and ensure execution on strategy
- Manage and drive the resource staffing plan
- Vendor Management / Contract Administration for SOW for labor/SW / HW in conjunction with CIO Office
- Partner with HR and IT Leaders to assist with talent development and succession planning
- Working/driving processes in organization including the Medicaid IT Project Management office
- Partner with HR/Legal/IT COS Office/Communications
- Driving Hiring/Terminations/Reductions in Force
- Overseeing SOW process/compliance
- Overseeing/delivering monthly reporting / metrics to the WLP CIO Office
- Communications for area
- Audit/Compliance SPOC
- Overseeing Medicaid EA (Enterprise Architecture) and liaison to WLP CTO office
- Ownership of Corporate Initiatives
- Ownership of SOW/Vendor Mgmt Liaison to WLP CIO office

Responsibilities:

1. Lead business process improvement initiatives and facilitates collaborative efforts to arrive at best practices.

2. Plan, perform and implement the design, implementation planning, implementation and maintaining of business processes and improvement initiatives. Works on issues where analysis of situations or data requires an in-depth knowledge of organizational objectives.

3. Lead the delivery of significant, quantifiable, annualized cost savings or customer satisfaction improvements.

4. Measure current organizational and process performance using a variety of qualitative and quantitative techniques including: one-on-one user interviews, surveys, observational studies and statistical analysis.

5. Provide business and technical expertise concerning business.

6. Creates process change by integrating new processes with existing ones and communicating these changes to impacted Business Systems teams.

7. Structure and conduct best practice research, process analysis, benchmarking and performance baselines measurement activities.

8. Work to ensure appropriate key operational indicators are in place for monitoring and analysis.

9. Maintain dashboard of key operational indicators, identifies and reports issues to management.

10. Identify opportunities for operational excellence and works to create seamless processes.

11. Work to resolve operational issues to include all functional disciplines within Amerigroup.

12. Maintain awareness of initiatives to ensure priority alignment and promotes communication and collaboration.

13. Recognize and utilize appropriate channels for communication, encourages two-way communication with Plan and Corporate staff to participate in creative program development resulting in improved efficiency and enhanced job performance.

14. Partner and support management across the company on assigned projects ensuring company goals and initiatives are met. May act as project manager in some cases.

15. Perform other duties as assigned/requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree or equivalent experience in Business, Health Care or related field.

Preferred:
- Master’s Degree.

Years and Type of Experience Required:

Required:
- 10 years relevant work experience and at least 5 years of leadership/management including project management experience in a medium to large size business environment.
- Minimum 3 years of demonstrated experience in data assimilation & analysis.

Preferred:
- Background in Healthcare or IT.
- Quality training a plus.

Specific Technical Skills

Required:
- Experience with change management.
- Experience with conflict resolution/mediation.
- Demonstrate mastery of process improvement methodology (i.e., Six Sigma certification and Work Out™) in appropriate timeframe as directed by management.
- Demonstrates high levels of flexibility by managing projects based on strategic priorities.
- Requires highest level understanding of organization's business systems and industry requirements.

Certifications or Licensures

Preferred:
- Six Sigma Black Belt certification.
- Project Management Professional (PMP™) certification.

Other:

Required:
- Excellent analytical, organizational, problem-solving, and communication skills.
- Ability to demonstrate political sensitivity and to work effectively with senior level management as well as with multi-disciplinary teams across department lines.
- Able to maintain strategic vision; ensures scope stays in alignment with corporate strategy.
- Demonstrated leadership in healthcare operations including root cause identification.
- Strong facilitation skills.
- Excellent interpersonal skills with the ability to promote team development.
- Strong leadership, coaching, and staff development skills.
- Strong knowledge of data management and interpretation.

SCOPE INFORMATION

# Direct Reports: 2-4

# Indirect Reports: Varies, depending upon project.

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 attend and participate in meetings.
- Must be able to travel as needed (approximately 25%) and adhere to Amerigroup travel policies and procedures.

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-AVP-Business-Improvement-IT-Chief-of-Staff-%28Telecommuters-Accepted%29-Job-VA-23450/2627213/262721326272132013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22920 # Positions 1
Location US-NV-Las Vegas
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/21/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for managing members experiencing complex or catastrophic illness, high risk pregnancy, injury and/or specialty illnesses such as diabetes, HIV, transplant, behavioral health conditions, etc., to ensure cost effective and efficient utilization of health services. Conducts continuous skills assessment, planning, implementation, coordination, monitoring and evaluation.

Responsibilities:

1. Obtains an accurate member history, conducts an assessment of biopsychosocial factors, and assesses clinical information to develop care plans including a member support system.

2. Establishes prioritized short and long term goals in collaboration with the member that meet the member’s needs and the referral source’s requirements.

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

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

5. Collaborates with the member’s PCP and specialists in the development of the plan of care to ensure that members’ physical needs are addressed; communicates care objectives to appropriate individuals/departments/referral sources.

6. Provide case management and/or disease management services to members, as identified by a health plan’s referral process.

7. May be required to conduct field visits.

8. May be required to perform service authorization duties using prescribed criteria and responsibilities as assigned and required by the Plan.

9. Acts as an advocate for an individual’s health care needs.

10. Reviews benefit systems and cost benefit analysis; evaluates the quality and necessity of applicable services; identifies members that would benefit from an alternative level of care; acquires data and evaluates necessary health services for cost containment; documents effectiveness of case management services.

11. Participates in Quality Improvement processes and serves on internal and external committees as required.

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of three years clinically related experience.

Preferred:
- Experience working on the community level and with community agencies.
- Experience in managed care, case management and discharge planning.

Certifications or Licensures

Required:
- Active licensed RN.
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.
- Will be required to complete the AGP internal IGCM Certification within the first 18 months of employment.

Preferred:
- Certified Case Manager.

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

Other
- Demonstration of cultural competency by exhibiting keen awareness of cross cultural values and beliefs, acceptance of the dynamics that result from cultural differences and works to create an atmosphere of acceptance, civility, and respect towards all populations.

ermHO
]]>http://www.amerigroup-jobs.com/job/Las-Vegas-Case-Manager-RN-Job-NV-89044/2609155/260915526091552013-07-18AmerigroupNursingfull-timeUSDstarting0BSLas Vegas, NV, US
Job ID 2013-21568 # Positions 1
Location US-NV-Las Vegas
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 1/2/2013
Additional Locations ..

More information about this job:
Summary:

The Coordinator Quality Management RN – Plan is responsible for developing, coordinating, implementing, and evaluating the continuous quality improvement activities for assigned populations(s) according to the established Quality management program. In collaboration with and under the direction of either Plan or Corporate Quality leadership, this position will assist in defining opportunities for improvement and collaborate with various internal and external participants to improve member experience, satisfaction, and sustainable outcomes. This position will also provide education in the area of quality improvement to departments, providers, and the community and assist in ensuring compliance with regulatory and accrediting organizations.

Responsibilities:

1. Design and implement quality improvement studies including selection of valid and reliable indicators, coordination of monitoring and evaluation activities, and medical record reviews.

2. Analyze data and prepare concise, accurate and meaningful quality management reports in accordance with QM principles.

3. Actively collaborate with Plan and/or Corporate teams to improve sustainable member outcomes.

4. Coordinate plan level resolution of member complaints/grievances in assigned population.

5. Educate providers and other organizational departments in the improvement of member outcomes and satisfaction for assigned population(s).

6. Assist in the preparation of information for RFIs, RFPS, and other QM related meetings and initiatives.

7. Conduct audits for all nationally delegated vendors and provider office visits to facilitate ongoing education and improvement for assigned populations.

8. Participate in provider office clinic days, health fairs, and community events to ensure maximum member benefit, improved data collection, and display a clinical presence.

9. Complete all other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associate’s degree in nursing or related field.

Preferred:
- Bachelor’s degree (or equivalent) in nursing or related field.

Years and Type of Experience Required:

Required:
- 2 years experience in quality improvement, risk management and/or utilization review in a managed care setting.

Preferred:
- Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting.

Certifications or Licensures

Required:
- Current professional RN license.

Preferred:
- CPHQ

Language Skills

Required:
- English

Preferred:
- Bilingual capabilities (Spanish or other)

Technical Capabilities
- Proficiency in company supported software (i.e., Excel, Outlook, Word)

Behavioral Competencies
- Good verbal and interpersonal skills.
- Good telephonic skills.
- Professional demeanor.
- Appreciation of cultural diversity and sensitivity toward populations served.
- Organizational skills and ability to multi-task.

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.
- Must be able to travel independently as needed and adhere to Amerigroup travel policies and procedures.
- Demonstration of cultural competency by exhibiting keen awareness of cross cultural values and beliefs, acceptance of the dynamics that result from cultural differences and works to create an atmosphere of acceptance, civility, and respect towards all populations.

ermHO
]]>http://www.amerigroup-jobs.com/job/Las-Vegas-Coordinator-Quality-MgtRN-Plan-Job-NV-89044/2356344/235634423563442013-07-18AmerigroupNursingfull-timeUSDstarting0BSLas Vegas, NV, US
Job ID 2013-22484 # Positions 1
Location US-NV-Las Vegas
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/26/2013
Additional Locations ..

More information about this 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.

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.

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

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

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

11. Performs other duties and special projects as assigned.

Qualifications:

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.

Certifications or Licensures

Required:
- Valid Driver’s License

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.

ermCS
]]>http://www.amerigroup-jobs.com/job/Las-Vegas-Provider-Relations-Rep-II-Job-NV-89044/2569050/256905025690502013-07-18AmerigroupCustomer Servicefull-timeUSDstarting0BSLas Vegas, NV, US
Job ID 2013-23108 # Positions 3
Location US-CA-North Hollywood
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 6/13/2013
Additional Locations ..

More information about this job:
Summary:

The Coordinator Quality Management RN – Plan is responsible for developing, coordinating, implementing, and evaluating the continuous quality improvement activities for assigned populations(s) according to the established Quality management program. In collaboration with and under the direction of either Plan or Corporate Quality leadership, this position will assist in defining opportunities for improvement and collaborate with various internal and external participants to improve member experience, satisfaction, and sustainable outcomes. This position will also provide education in the area of quality improvement to departments, providers, and the community and assist in ensuring compliance with regulatory and accrediting organizations.

Responsibilities:

1. Design and implement quality improvement studies including selection of valid and reliable indicators, coordination of monitoring and evaluation activities, and medical record reviews.

2. Analyze data and prepare concise, accurate and meaningful quality management reports in accordance with QM principles.

3. Actively collaborate with Plan and/or Corporate teams to improve sustainable member outcomes.

4. Coordinate plan level resolution of member complaints/grievances in assigned population.

5. Educate providers and other organizational departments in the improvement of member outcomes and satisfaction for assigned population(s).

6. Assist in the preparation of information for RFIs, RFPS, and other QM related meetings and initiatives.

7. Conduct audits for all nationally delegated vendors and provider office visits to facilitate ongoing education and improvement for assigned populations.

8. Participate in provider office clinic days, health fairs, and community events to ensure maximum member benefit, improved data collection, and display a clinical presence.

9. Complete all other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associate’s degree in nursing or related field.

Preferred:
- Bachelor’s degree (or equivalent) in nursing or related field.

Years and Type of Experience Required:

Required:
- 2 years experience in quality improvement, risk management and/or utilization review in a managed care setting.

Preferred:
- Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting.

Certifications or Licensures

Required:
- Current professional RN license.

Preferred:
- CPHQ

Language Skills

Required:
- English

Preferred:
- Bilingual capabilities (Spanish or other)

Technical Capabilities
- Proficiency in company supported software (i.e., Excel, Outlook, Word)

Behavioral Competencies
- Good verbal and interpersonal skills.
- Good telephonic skills.
- Professional demeanor.
- Appreciation of cultural diversity and sensitivity toward populations served.
- Organizational skills and ability to multi-task.

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.
- Must be able to travel independently as needed and adhere to Amerigroup travel policies and procedures.

ermHO
]]>http://www.amerigroup-jobs.com/job/North-Hollywood-Coordinator-Quality-MgtRN-Plan-Job-CA-91601/2662599/266259926625992013-07-18AmerigroupNursingfull-timeUSDstarting0BSNorth Hollywood, CA, US
Job ID 2013-22997 # Positions 1
Location US-CA-North Hollywood
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/31/2013
Additional Locations ..

More information about this job:
Summary:

The Manager of Quality Management is responsible in conjunction with the plan leadership for developing, coordinating, and implementing quality initiatives within the health plan. Provides process and technical supervision to a team responsible for monitoring and evaluating the quality of care/service, appropriateness, continuous improvement, member satisfaction, and results of actions across the continuum of care to members. Assist in coordinating the quality management program activities throughout the functional areas of the health plan.

Responsibilities:

1. Assists in establishing objectives and annual goals in conjunction with the plan leadership.

2. In conjunction with the plan QM leader, implements the comprehensive Quality Management Program to meet the demographic and epidemiological needs of the population served.

3. Promotes plan-wide understanding, communication, and coordination of the quality management program.

4. Manages and evaluates team’s performance and ensure adherence to department’s standards.

5. Trends quality data and develops aggregate and individual plan reports as indicated. Analyzes validity of data/reports.

6. Coordinates on a quarterly basis reporting of all quality/risk initiatives to all appropriate committees.

7. Develops, designs, implements and evaluates activities including coordination of focus studies and other indicators of quality of care/service.

8. Coordinates development, implementation, and evaluation of continuous quality improvement action plans for the improvement activities.

9. Participates in the reporting of Plan data and coordinates the improvement action plans.

10. Coordinates the state regulatory quality reporting for the health plan.

11. Provides support for provider recredentialing in the areas of medical record reviews, quality indicators and trended data.

12. Assures compliance with State and Federal quality improvement requirements. Prepares plan staff for successful State and internal audits.

13. Maintains liaison for quality initiatives with State and Federal regulatory agencies as needed.

14. Evaluates and makes recommendations for oversight of delegated services.

15. Assists in developing the annual operating and capital budgets to sufficiently meet departmental needs and ensures that department stays within budget and accounts for variances.

16. Interviews, manages, evaluates, and develops new and existing departmental staff.

17. Recognizes and utilizes appropriate channels for communication and encourages two-way communication and encourages staff to participate in creative program development.

18. Work collaboratively with key health care professionals toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problem resolution.

19. Effectively communicates information to superiors, team members, and other appropriate staff in a timely, accurate, and courteous manner.

20. Actively participates in meetings and helps maintain an effective work group.

21. Develops presentations on activities for a variety of audiences as needed.

22. Plan and execute an annual member and provider outreach plan.

23. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associates Degree or equivalent work experience.

Preferred:
- Bachelors Degree, or MSN, MPH, MPA.

Years and Type of Experience Required:

Required:
- Minimum of 5 years of current experience in quality improvement, and/or utilization review in HMO setting with at least 1 year management/leadership experience.

Preferred:
- Previous NCQA accreditation and HEDIS reporting experience.
- Experience with the urban Medicaid population.

Certifications or Licensure

Required:
- N/A

Preferred:
- Current state RN license preferred, Risk Management License preferred; CPHQ preferred.

Other:

Required:
- Strong knowledge base in areas of quality improvement.
- Excellent written and verbal communication skills.
- Ability to work effectively with physicians and other health care providers as well as with multi-disciplinary teams across department lines.
- Excellent problem solving skills.
- Demonstrates strong organizational skills.
- Knowledge of basic computers including word processing and spreadsheets.
- Ability to work in a team environment.
- Ability to develop and give presentations.
- Ability to handle multiple tasks.
- 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.

ermHO
]]>http://www.amerigroup-jobs.com/job/North-Hollywood-Manager%2C-Quality-Management-Job-CA-91601/2633194/263319426331942013-07-18AmerigroupNursingfull-timeUSDstarting0BSNorth Hollywood, CA, US
Job ID 2013-22129 # Positions 1
Location US-NATIONWIDE
Search Category Legal
Type Regular Full-Time (30+ hours) Posted Date 2/27/2013
Additional Locations ..

More information about this 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.

Relocation to Virginia Beach is preferred

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 or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Juris Doctor (JD) or Legum Baccalaureus (LLB).

Years and Type of Experience Required:

Required:
- Minimum of 7 years of legal experience including provider contracting experience with at least 3 years of leadership/management experience.

Certifications or Licensures

Required:
- Member in good standing of a state bar with eligibility to obtain Virginia Bar in-house counsel status.

Language Skills

Required:
- English

Functional Competencies
- Proficient with various computer programs including Microsoft Word, Outlook, Excel and Access.
- Experience with contract database software.

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.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-AVP-Senior-Counsel-Job-VA-23450/2453562/245356224535622013-07-18AmerigroupLegalfull-timeUSDstarting0BS, ,
Job ID 2013-22296 # Positions 1
Location US-NATIONWIDE
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 3/14/2013
Additional Locations ..

More information about this job:
Summary:

As part of the Medicare Risk Adjustment team, the Health Care Analytics III will develop expert knowledge of the CMS-HCC risk adjustment model, its concepts and methodology in order to reconcile CMS risk score reports and project future revenue related to risk adjustment. In addition to ensuring the accuracy, quality and integrity of the data, this person will perform detailed and complex analyses in order to evaluate risk score trends with special focus on provider-level reporting. The ideal candidate for this position will be proficient in SQL or SAS and have a strong analytic experience; additionally, they need to be results oriented and willing to do whatever it takes to manage a project to completion. Experience with risk adjustment is preferred.

The Analyst III is responsible for collecting, analyzing and interpreting health care data, including claims, clinical, member, and provider information applying problem solving skills to deal creatively with complex less clearly defined situations. Works directly with Plan and Corporate Office customers and business owners to provide solutions to problems of diverse scope with the goal of identifying areas of opportunity for formulation and implementation of strategic initiatives.

Responsibilities:

1. Responsible for conducting advanced data management.

2. Develops and executes complex programs to produce reporting deliverables.

3. Performs business requirements gathering and analysis.

4. Provides technical and/or analytical support as well as professional development to Plan Performance measurement staff.

5. Collaborates with internal and external partners and organizations to understand data needs and design analytic studies to answer business and research questions.

6. Independently structures advanced level project plans for analytical projects.

7. Interprets results and prepares findings for presentation to internal and external audiences.

8. Conducts quality reviews on own and peers’ work products.

9. Integrates feedback to drive continuous improvement and grow subject matter knowledge.

10. Applies advanced financial, clinical and/or operational analysis.

11. Monitors and identifies unit cost and/or utilization risks to AMERIGROUP’s medical cost budget.

12. Adheres to all applicable compliance standards.

13. Other job duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Finance, Economics, Business Administration or a related discipline or equivalent experience.

Years and Type of Experience Required:

Required:
- Minimum of five years of related work experience in data analysis, report development, application development/implementation and /or project management.

Preferred:
- Minimum of two years experience with Managed Care Organization.
- Minimum of two years experience with government health care programs.

Language Skills

Required:
- English

Technical Competencies

Computer Skills and Office Equipment
- Proficiency with Microsoft Office products, Excel in particular.
- Programming language such as SQL or SAS preferred Communication skills: Verbal, Written and Telephonic.
- Strong capability to provide professional and appropriate written and verbal information to internal and external customers.
- Strong customer service/relationship skills and ability to work effectively and multi-task in a fast paced environment with shifting priorities.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track. Surfaces problems and issues before projects get derailed.

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 procedure.

ermHO
]]>http://www.amerigroup-jobs.com/job/Medicare-Risk-Adjustment-Analyst-III-%28position-located-in-Virginia-Beach%29-Job/2480263/248026324802632013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BS, ,
Job ID 2013-22519 # Positions 1
Location US-NATIONWIDE
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 4/8/2013
Additional Locations ..

More information about this job:
Summary:

The Health Care Economics (HCE) Analyst Principal I is responsible for analyzing complex business problems, and for having an extensive knowledge of the applications, data, associated technologies and/or analytic methods for the supported area. This position serves as a subject matter expert, leading cross-functional teams to address business or systems issues. Moreover, this position acts as an advocate to ensure quality and timeliness of project deliverables, and provides leadership within the team, department and organization. The HCE Principal I also analyzes health care and financial data, to determine compliance with goals and objectives, displaying a high level of critical thinking and analysis. Additional tasks include the development and maintenance of positive client relationships in functioning as the liaison between the business, health plans, operational areas and Information Technology Services (ITS). Works with staff to ensure business requirements are incorporated into system design and testing, where applicable. Supports departmental methodologies and provides input for improvement to tools and processes. Works on complex issues where analyses of situations or data require an in-depth evaluation.

Responsibilities:

1. Serves as the point of authority in the analysis of complex health care issues, including analysis of both health care utilization and cost metrics, complex financial analysis and development of advanced analytic outputs and/or services, as required. Responsible for overseeing the development of analytic narratives that include executive summaries, significant findings, conclusions and recommendations for action.

2. Performs detailed requirements documentation, analysis, design, configuration, as well as process and data flow diagramming for processes of high complexity. Understands and considers the relationship between processes and business policies.

3. Functions as a liaison between own department, health plans, functional areas, and ITS.

4. Identifies risks and multiple solutions.

5. Recommends and implements improvements to existing procedures. Influences others to follow existing procedures.

6. Where applicable, leads all system/application testing for implementations, conversions, upgrades and updates including individual claim and batch testing. Ensures all application updates are implemented timely.

7. Where applicable, evaluates 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 defects. Coordinates problem resolution with development and/or product vendors.

8. Reads and interprets design document conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

9. Where applicable, develops and analyzes advanced analytic outputs and/or services, including predictive models, decision trees, forecasting and optimization analysis. Monitors model performance to ensure standards are met. Coordinates optimal business operationalization of advanced analytics outputs or services.

10. Develops complex queries and reports. Perform database updates, where applicable.

11. Validates proposed contracts meet requirements taking into consideration financial arrangements and impacts as they apply to the budget as applicable in functional area of responsibility.

12. Makes technical and functional business recommendations based on evolving technologies and evolving application trends to include infrastructure, software, database, and networks.

13. Addresses business challenges to improve efficiency and decision making, reduce redundancy, and ultimately enhance business results.

14. Manages multiple priorities and projects.

15. Leads and mentors functional area team members and other Business Analysts.

16. Manages project related budgets as applicable in functional area of responsibility.

17. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Engineering, Statistics, Computer Science or a related discipline. Equivalent experience in a Business or Systems Analyst role is acceptable in lieu of a degree(s).

Preferred:
- Master’s degree

Years and Type of Experience Required:

Required:
- 8 years experience in systems analysis, or business analysis.

Preferred:
- Health Care industry experience.

Certifications or Licensures

Preferred:
- CBAP (Certified Business Analyst Professional)

Language Skills

Required:
- English

Technical Competencies

Required:
- Comprehensive knowledge of core analytics applications and systems.
- Advanced knowledge and skills as a subject matter expert in health data analysis as well as financial analysis.
- 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.
- Able to develop creative strategies and tap the creative potential of individuals and groups.
- Able to continually assess needs and implement measures to ensure customer expectations are met or exceeded.
- Able to turn problems into opportunities for change.
- Advanced proficiency with all applicable company supported software applications.
- Able to apply configuration knowledge to resolve complex business issues, identify alternatives, determine impact, and recommend optimal configuration solutions.
- Comprehensive working knowledge of managed care operational areas and managed care products in each market in which AGP operates, including current trends in the industry.
- Advanced understanding of data architecture.
- Advanced understanding of infrastructure associated with supported applications.
- Extensive knowledge of analysis techniques and standards and set analysis standards.
- Comprehensive understanding of how each department/health plan relates to the organization as a whole.

Computer Skills and Office Equipment - Advanced
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data. Ability to use software to conduct data analysis, reporting and sharing of information to solve problems. Ability to use complex applications or software to analyze and solve business problems. Spreadsheet Utilization and Management Advanced: Expert level of proficiency in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools.

Database Utilization and Database Management - Intermediate

Proficient in database utilization including ability to conduct queries and design databases, and perform multiple table query design. Systems Expert: Understands systems development lifecycle. Understanding of system's utilization and considered a systems SME for applications that support the HCE Analytic Platforms.

Applications/Tools - Intermediate
- Aability to leverage available tools such as: TOAD, Microsoft Project, Microsoft query analyzer SQL mgr, SAS, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity - Basic
- General healthcare, who are our providers (hospitals physicians, ancillary providers) who are payors (insurance companies), - High level claims process, knowledge of general industry how it works, including HIPAA.
- More specific knowledge around reimbursement methodology, fee schedules, per case, per diem, DRG, % of charges.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping DRG codes, place of service codes (POS),
- Government Programs Specific Knowledge: *Medicare Medicaid programs, CHIP and LTC. *Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Gather and Document Requirements - Expert
- Mentors others. Viewed as a SME.
- Ability to prepare the most complex requirements documents.
- Ability to facilitate requirements gathering including determining the most efficient and effective way to capture the requirements, and managing kick off and subsequent status meetings.
- Ability to manage timelines and due dates.
- Ability to recognize and understand business changes that impact requirements and incorporate changes into documentation.

Contracts - Intermediate
- Ability to read a contract and understand the operational requirements the contract creates.
- Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving (Analytics) - Advanced
- Ability to understand moderate to complex business process flows (complex, corporate or enterprise-wide). Ability to thoroughly understand, analyze and synthesize data, including relationships of data, e.g. cause/effect. Ability to conduct business analysis, requirements gathering, process analysis and gap analysis.

Project Management - Advanced
- Skilled in running multiple projects utilizing standard project management tools, techniques and methodology.
- Keeps projects on task.

Testing - Advanced
- Advises and mentors others. Functions independently in the creation of moderate to complex test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams. - Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability/Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Health-Care-Economics-Analyst-Principal-I-%28position-located-in-Virginia-Beach%29-Job/2535073/253507325350732013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BS, ,
Job ID 2013-22593 # Positions 1
Location US-FL
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 4/15/2013
Additional Locations ..

More information about this job:
Summary:

This position requires strong functional skills in technology, business process engineering and business planning and execution. Incumbents will provide day to day management to a team of associates working on configuration activities, and must have broad operational knowledge, effective communication skills and a experience in healthcare systems and processes.

Responsibilities:

1. Provides 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 multiple systems.

2. Manages day-to-day configuration activities within Health Plan Services. This includes crisis escalation and resolution, interaction with business owners and management of the intake, configuration and business analysis staff.

3. Develops and maintains relationships with Health Plan customers relative to configuration operations.

4. Works with internal stakeholders to resolve cross-functional issues related to configuration, claims payment, provider set-up, etc.

5. Ensures project deadlines are met and service levels meet agreed-upon standards with business owners.

6. Creates solutions with architectures that minimize complexity, effort, and maintenance while fully accomplishing the project and business objectives.

7. Communicates best practices for application configuration.

8. Allocates resources efficiently to meet multiple project deadlines and accomplish the objectives of the assigned initiatives.

9. Ensures that all department initiatives have clear business goals and success metrics.

10. Monitors and reports on the performance of the department including actual versus expected results and project duration.

11. Manages and develops staff by giving performance reviews, recruitment, career development and mentoring programs.

12. Performs other duties as assigned.

Qualifications:

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:
- Five years of configuration experience providing pricing and/or benefits configuration support with two years of leadership/management experience.

Certifications or Licensures

Preferred:
- Current Project management Professional (PMP) certification.

Language Skills

Required:
- English

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Mgr-Health-Plan-Services-Job/2546966/254696625469662013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BS, ,
Job ID 2013-22605 # Positions 2
Location US-NATIONWIDE
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 4/17/2013
Additional Locations ..

More information about this job:
Summary:

Exercises wide latitude in performing responsibilities for both the strategic and tactical development of the data architecture. Lead enterprise wide data standards, conceptual and logical modeling for applications and data warehouse initiatives to ensure consistent usage and standards. Possess state-of-the-art knowledge.

Responsibilities:

1. As a recognized technical expert translates business needs into long term data architecture solutions utilizing process flows and data flow techniques. Provide in depth knowledge of companywide business processes and advance knowledge of industry standard business process.

2. Defines, designs and builds conceptual and logical model from business requirements. Works on significant issues where analysis of situations or data requires in-depth evaluation.

3. Analyzes and documents complex data flow between corporate databases.

4. Manages and leads data quality program for multiple subject areas.

5. Creates, reviews, and manages data models and the metadata repository and related standards.

6. Works with database administrators and development staff to ensure data standards are met. Influences and recommends technical direction and standards.

7. Leads validation effort for data architecture projects.

8. Contributes to budget development and manages designated components of operating budgets in support of department budget management.

9. Develops plans that support the department business plan. Responsible for developing contingency plans to ensure department business plan objectives are met.

10. Actively participates in initiation, amendment, renewal and termination of contracts. Participates in the coordination between Amerigroup’s Legal department, ITS Program Management, and vendor's Legal department.

11. Performs other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree. Equivalent experience is acceptable in lieu of a degree(s).

Preferred:
- Bachelor of Science in Information System or Computer Science.
- Master’s degree preferred.

Years and Type of Experience Required:

Required:
- A minimum of 12 years of relevant work experience.

Preferred:
- Managed care / health care background.

Language Skills

Required:
- English

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 0 - 25

Budgetary $ Responsibility: $0 - $5m

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.

CB1

D: JR

ermIT
]]>http://www.amerigroup-jobs.com/job/ITS-Data-Architect-Principal-II-%28Telecommuters-Accepted%29-Job/2551826/255182625518262013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BS, ,
Job ID 2013-22609 # Positions 2
Location US-NY-New York
Search Category Administrative Services
Type Regular Full-Time (30+ hours) Posted Date 4/18/2013
Additional Locations ..

More information about this job:
Summary:

Support the Marketing Department goals, objectives and initiatives by driving and maintaining vehicles in a safe and effective manner. Support Marketing by dispersing marketing materials in the various communities and ensure the Amerigroup signature events are properly equipped to support the marketing representatives.

This position is in College Point, NY.

Responsibilities:

1. Safely transport staff and supplies to/from Company sponsored events, activities, residences, etc.

2. Maintain the safety and cleanliness of vehicles driven; perform routine safety inspections on a daily basis.

3. Ensure that supply levels of assigned vehicles are properly maintained.

4. Participate in event set-up and break-down, including loading and unloading equipment from storage to site.

5. Ensure all Marketing Reps are provided with appropriate marketing materials in a timely fashion.

6. Accountable for all tracking of inventory.

7. Maintain an organized storage facility.

8. Maintain vehicle maintenance and appearance.

9. Performs other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High school

Years and Type of Experience Required:

Required:
- 2-3 years driving experience

Other:

Required:
- Maintain an outstanding safety traffic law compliance record.
- Perform safety inspections per schedule.
- Maintain an excellent attendance and punctuality record.
- To perform this job successfully, the individual must have strong communication skills.
- Attend all marketing meetings, events and activities at appointed timeframes.
- Load and unload various materials, boxes and assorted items and transport to various marketing sites.
- Maintain inventory controls.

Certifications or Licensures

Required:
- State or Local Driver’s License (CDL Preferred).
- DMV report required – 3 years without tickets or accidents.
- All drivers of an RV must have a current Medical Examiners Certificate confirming the passing of a DOT physical exam as required by the state or state contract in which they are driving.

Language Skills

Required:
- English

Technical Competencies
- Ability to operate a computer.

Behavioral Competencies
- Ability to work well within a team.
- Relationship building.

SCOPE INFORMATION

# Direct Reports:

# 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 travel as needed and adhere to Amerigroup travel policies and procedures.
- Standing or sitting for long periods.
- Lifting up to 50 pounds.

ermCorp
]]>http://www.amerigroup-jobs.com/job/New-York-Driver-Plan-Job-NY/2554482/255448225544822013-07-18AmerigroupAdministrative Servicesfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22670 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/24/2013
Additional Locations ..

More information about this job:
Summary:

The AVP of Quality Management provides leadership in the development, coordination, implementation, and evaluation of the continuous quality improvement initiatives throughout the company in the areas of quality of care, quality of service, and provider/member satisfaction. Provides direction, leadership and education for compliance with NCQA standards to achieve and maintain NCQA accreditation. Maintains liaison with state and federal regulatory agencies. Supports health plan coordination of the quality management program across the company by sharing replicable technology, benchmarking, and best practices. Works to establish and promote a culture of organizational excellence.

Responsibilities:

1. Directs and provides leadership for implementing, monitoring and evaluating the Quality Management Program for the health plan ensuring the demographic and epidemiological needs of the population served are met.

2. Establishes objectives and annual goals in conjunction with the CEO and Medical Directors.

3. Oversees implementation and evaluation of the scope of the quality management program.

4. Promotes plan-wide understanding, communication, and coordination of the quality management program.

5. Directs and provides leadership for Plan compliance with NCQA standards.

6. Provides leadership for the interpretation of results and development of improvement action plans arising from provider and member satisfaction surveys.

7. Serves as a resource for design of quality improvement studies, indicators, data collection, and data trend analysis/interpretation.

8. Provides leadership in developing, monitoring, and evaluating HEDIS improvement action plans.

9. Participates in market development activities through due diligence activities.

10. Provides leadership for health plan QM activities through sharing of replicable technology/benchmarking/best practices, assisting with review preparation, and providing guidance in quality improvement activities.

11. Provides coaching for development of QM personnel.

12. Works to establish and promote organizational excellence throughout the health plans.

13. Monitors compliance with State and Federal quality improvement/assurance requirements.

14. Evaluates and makes recommendations for oversight of delegated services.

15. Develops the QM department annual operating and capital budgets to sufficiently meet departmental needs, and ensures the department stays within budget, and accounts for variances. 16. Interviews, manages, evaluates, and develops new and existing departmental staff.

17. Recognizes and utilizes appropriate channels for communication, encourages two-way communication, and encourages staff to participate in creative program development.

18. Effectively communicates information to superiors, team members, and other appropriate staff in a timely, accurate, and courteous manner.

19. Provides leadership/facilitation for groups as needed.

20. Represents Quality Management through group presentations on various topics for a variety of internal and external audiences.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor Degree.

Preferred:
- MSN, MPH, MPA.

Years and Type of Experience Required:

Required:
- Minimum of 10 years experience in quality management, quality improvement, risk management, and/or utilization review in HMO setting and 5 years of leadership/management experience. - Previous NCQA accreditation and HEDIS reporting experience required.

Specific Technical Skills

Required:
- Knowledge of basic computers including word processing and spreadsheets.

Preferred:
- Knowledge of data base applications.

Certifications or Licensure

Preferred:
- Current RN state license (or as required by Plan).
- CPHQ.

Other:
- Strong knowledge base in areas of quality improvement, accreditation, HEDIS, satisfactory survey process, and organizational improvement.
- Excellent written and verbal communication skills.
- Ability to work effectively with physicians and other health care providers as well as with multi-disciplinary teams across department lines.
- Excellent problem solving skills.
- Demonstrates strong organizational skills.
- Strong leadership, coaching, and staff development skills.
- Ability to develop and give presentations and to facilitate groups.
- Ability to handle multiple tasks.
- Appreciation of cultural diversity and sensitivity towards target population.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a phone.
- Must be able to travel on common carriers and to adhere to AMERIGROUP’s travel policies.

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-AVP-Quality-Management-Plan-Job-NY/2564572/256457225645722013-07-18AmerigroupNursingfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22662 # Positions 1
Location US-NY-New York
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/24/2013
Additional Locations ..

More information about this job:
Summary:

Provide development and maintenance of rules, policies and procedures, and educational processes focused on ensuring organizational compliance with industry standard coding practices. Interpret and apply National Uniform Billing Compliance rules, guidelines, laws and industry trends to support, provider reimbursement, system configuration and ongoing provider education. 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.

Responsibilities:

1. Provides development and maintenance of rules, policies and procedures for coding and reimbursement based upon an extensive understanding of current guidelines and trends (i.e. coding for non-covered, exceptions, capitation, state and federal mandates regarding coding). This also includes state and federal communication media related to coding and cross-walks, industry standard code sets (i.e. CPT, HCPCS, Revenue, ICD.9, DRG, etc.), and medical compliance and reimbursement policies such as medical necessity issues and proper coding.

2. Conducts internal coding reviews and/or audits as required. Review and validate coding related to provider billing, contracts, rate sheets etc. Provide recommendations for development of standards.

3. Provides technical guidance for configuration coding to the Business Configuration department. Assist in the resolution of provider reimbursement configuration or claims payment issues as needed.

4. Implements and manage applications and processes for clinical classification and coding of health care services.

5. Correlates findings with appropriate actions including but not limited to provider education, cost recovery, cost avoidance, policy and coverage guidelines.

6. Assists in evaluation, design and implementation of strategies to send communication to providers who are billing out of normal ranges. Strategies include training provider, monitoring impact, responding to inquiries, calls etc.

7. Interfaces with operational department management on industry standards and National Uniform Billing Compliance issues.

8. Actively develops and participates in training activities related to coding.

9. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in Health Care Management, Accounting, Business or equivalent experience is acceptable in lieu of a degree(s).

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, medical billing, medical coding, auditing, or health data analytics setting preferred.

Certifications or Licensures

Required:
- AAPC (CPC) or AHIMA coding certification (CCS). Must maintain licensure, i.e. completion of annual continuing professional education requirements.

Language Skills

Required:
- English

Functional Competencies

Required:
- Experience in analysis in health care utilization, clinical or managed care environment.
- 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.

Preferred:
- Previous experience auditing professional and/or facility coding 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.

ermCS
]]>http://www.amerigroup-jobs.com/job/New-York-Medical-Coding-Analyst-Auditor-CPC-Certified-Job-NY/2564575/256457525645752013-07-18AmerigroupCustomer Servicefull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22496 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/26/2013
Additional Locations ..

More information about this job:
Summary:

The Coordinator Quality Management RN – Plan is responsible for developing, coordinating, implementing, and evaluating the continuous quality improvement activities for assigned populations(s) according to the established Quality management program. In collaboration with and under the direction of either Plan or Corporate Quality leadership, this position will assist in defining opportunities for improvement and collaborate with various internal and external participants to improve member experience, satisfaction, and sustainable outcomes. This position will also provide education in the area of quality improvement to departments, providers, and the community and assist in ensuring compliance with regulatory and accrediting organizations.

The job responsibilities for this position include:

Maintaining regulatory compliance by managing the medical necessity appeals and grievances process. Applicant must have extensive knowledge of accreditation requirements for MNA and complaints including NCQA. Preferred applicant will have an extensive knowledge of federal and state managed care regulations. CB1

Responsibilities:

1. Design and implement quality improvement studies including selection of valid and reliable indicators, coordination of monitoring and evaluation activities, and medical record reviews.

2. Analyze data and prepare concise, accurate and meaningful quality management reports in accordance with QM principles.

3. Actively collaborate with Plan and/or Corporate teams to improve sustainable member outcomes.

4. Coordinate plan level resolution of member complaints/grievances in assigned population.

5. Educate providers and other organizational departments in the improvement of member outcomes and satisfaction for assigned population(s).

6. Assist in the preparation of information for RFIs, RFPS, and other QM related meetings and initiatives.

7. Conduct audits for all nationally delegated vendors and provider office visits to facilitate ongoing education and improvement for assigned populations.

8. Participate in provider office clinic days, health fairs, and community events to ensure maximum member benefit, improved data collection, and display a clinical presence.

9. Complete all other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associate’s degree in nursing or related field.

Preferred:
- Bachelor’s degree (or equivalent) in nursing or related field.

Years and Type of Experience Required:

Required:
- 2 years experience in quality improvement, risk management and/or utilization review in a managed care setting.

Preferred:
- Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting.

Certifications or Licensures

Required:
- Current professional RN license.

Preferred:
- CPHQ

Language Skills

Required:
- English

Preferred:
- Bilingual capabilities (Spanish or other)

Technical Capabilities
- Proficiency in company supported software (i.e., Excel, Outlook, Word)

Behavioral Competencies
- Good verbal and interpersonal skills.
- Good telephonic skills.
- Professional demeanor.
- Appreciation of cultural diversity and sensitivity toward populations served.
- Organizational skills and ability to multi-task.

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.
- Must be able to travel independently as needed and adhere to Amerigroup travel policies and procedures.

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Coordinator-Quality-RN-Fair-Hearings-Job-NY/2569049/256904925690492013-07-18AmerigroupNursingfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22667 # Positions 2
Location US-NY-New York
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 4/30/2013
Additional Locations ..

More information about this job:
Summary:

The Outreach Associate is responsible for providing support for clinical quality initiatives, regulatory/contractual requirements, and outreach activities to improve member experience and outcomes. Support may include telephonic, written, and/or face-to-face interactions with members and providers of an assigned population(s). This position may also provide assistance in the areas of member education classes, health promotion initiatives and data collection and recording.

PRIMARY RESPONSIBILITIES for this position include:

Conducting Telephonic outreach and/or home visits to facilitate preventative screening and provide education to members for treatment of illnesses and management of chronic conditions utilizing approved resources and materials. This position will require you to work in a telephonic work environment, completing more than 100 phone calls a day to members and providers to collect data and coordinate health care services. You will support the Health Education Department with off premise education events and home visits to members may be required.

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.

3. Conduct telephonic outreach and/or home visits to facilitate preventive screenings and provide education to members utilizing approved resources and materials.

4. Collect member encounter data and medical records, reviewing for completeness, and document member participation of activities as appropriate.

5. Assist members in making appointments with his/her Primary Care Physician (PCP) and/or Specialist as indicated.

6. Ensure members have seen their PCP and completed, or are in process of completing, their treatment plan or preventive care services as advised.

7. Assist members in identifying community resources, obtaining information related to classes and programs, and provide support for identified learning needs for the required level of care.

8. Promote and support a professional relationship with providers and community resources by participating in community education events, health fairs, and clinic days as needed.

9. Refer issues and concerns about members to the appropriate plan or corporate leader.

10. Performs all other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High school diploma or equivalent.

Preferred:
- College degree or equivalent.

Years and Type of Experience Required:

Required:
- One year experience in healthcare or managed care industry.
- Some understanding of medical terminology.

Preferred:
- Experience in a health related service such as community outreach worker, home health aide, etc.

Certifications or Licensures

Required:
- Valid Driver’s License

Language Skills

Required:
- English

Preferred:
- Bilingual capabilities in Spanish or other.

Technical Competencies
- Proficiency in company supported software (i.e., Excel, Outlook, Word).

Behavioral Competencies
- Good verbal and interpersonal skills.
- Good telephonic skills.
- Professional demeanor.
- Appreciation of cultural diversity and sensitivity toward populations served.
- Organizational skills and ability to multi-task.

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.
- Must be able to travel independently as needed and adhere to Amerigroup travel policies and procedures.

For NY Plan Outreach only:
- 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).

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Outreach-Assoc-Job-NY/2575523/257552325755232013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22637 # Positions 1
Location US-NATIONWIDE
Search Category Finance
Type Regular Full-Time (30+ hours) Posted Date 4/19/2013
Additional Locations ..

More information about this job:
Summary:

The VP Finance (Plan) is responsible for owning, managing, and driving the budgeting, forecasting, and financial analysis functions of the health plan or region to ensure the achievement of membership, premium, medical expense, gross margin, and local SG&A goals on a quarterly and annual basis. Major activities owned by this position include the annual budget, quarterly forecasts, financial statement analysis and interpretation, ownership of the ACT process to maximize gross margin, and participation in the premium rate-setting process. The VP will work collaboratively with health plan and corporate management in all areas of responsibility to ensure the organization is focused on current results vs. budget, current financial performance trends, and the identification and execution of initiatives to properly manage revenue, medical, gross margin, and SG&A to plan.

Responsibilities:

1. Own topline, medical expense, and local/direct SG&A portions of annual budget process & quarterly forecasts:

a. Drive process with Plan leadership in conjunction with CEO/COO.

b. Conduct/coordinate all analysis required for membership, premium yield, medical expense, and local/direct admin by product.

c. Provide all required files to Home Office Finance departments within required timeframes.

2. Provide updated topline and medical projections as needed by the Home Office due to material changes in the business environment (new membership, new product, new provider contract, etc.)

3. On a monthly and quarterly basis, provide necessary information to Actuarial for the medical accruals including:

a. Large cases not in claim experience.

b. Major contract changes not in claim experience.

c. Other utilization or unit cost events not in claim experience.

4. Full participation in monthly operational meetings, financial statement meetings, and medical accrual meetings.

5. On a quarterly basis, provide all necessary information for the other known liabilities, including detailed analysis for auditor review, within required timelines of close process.

6. On a monthly basis, analyze, interpret, and communicate financial statement and medical accrual results to plan leadership for the month, quarter-to-date, and year-to-date:

a. Identify and explain all variances to budget/forecast.

b. Identify trends & key drivers in revenue and medical and roll them into ACT process for action.

c. Assess impact on quarterly and full year budget/forecast targets for topline, medical expenses, gross margin, HBR, and pre-tax/pre-corporate earnings.

7. Own the ACT program and ensure its success for the health plan in achieving revenue, medical, and gross margin targets on a quarterly and annual basis according to budget/forecast.

8. Conduct and manage all required analysis for the ACT program:

a. Identify, assess, document, and monitor all opportunities to maximize revenue and manage medical expenses to budget/forecast through membership, premium rate, unit cost, utilization, and cost containment initiatives.

b. Ensure 150% of gross margin gap to budget/forecast is explained at all times.

c. Fully utilize process tools and methodologies in accordance with Corporate standards.

9. Fully engage with other Plans and Home Office departments to identify, define, and use standard tools and analytical approaches, including use of common data sets. Interaction with Medical Finance, Finance, Medical Management, Claims, Cost Containment, Provider Service Operations, and Premium Reconciliation is expected.

10. Participate and contribute to “Best Practice” forums with other Plans and Home Office to share initiative successes, share lessoned learned, identify best practices across the company, and identify new initiatives not currently implemented at the Plan.

11. Monitor monthly cost containment activity, including investigation and resolution of adverse changes in collection activity a. Provide direction to Cost Containment Unit for additional expense savings opportunities not taken.

12. Monitor monthly claims production, including investigation and resolution of adverse changes in production statistics and their impact on medical accrual estimates.

13. Monitor monthly supplemental revenue collections such as Maternity kick payments, Newborn kick payment, and reimbursable drugs, including investigation and resolution of adverse changes in collection activity.

14. Monitor, analyze, and report any variances for local and direct administration expenses.

15. Identify and drive opportunities for savings with Plan leadership on a monthly basis.

16. Work with Actuarial to understand key drivers of the premium development for each product.

17. Identify and monitor the assumptions and issues in the rate methodology that drive financial success including trend, populations covered, benefits covered, unit cost assumptions, risk adjustment, birth rates, newborn enrollment rules, special populations (i.e. AIDS/HIV), utilization assumptions, and program changes.

a. Communicate to key Plan leadership and ensure they understand the drivers of success underneath the premium rates.

b. Monitor performance against quantifiable drivers of premium rates and resolve adverse variances as they arise.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- MBA or CPA

Years and Type of Experience Required:

Required:
- 12+ years Managed Care Finance, Accounting, or Actuarial experience in a leadership role in a health plan and at least 5 years leadership management experience.

Specific Technical Skills

Required:
- Proficient in Microsoft Windows environment including the Office suite of products, proficiency with database programs such as Microsoft Access, advanced skills in Microsoft Excel, advanced analytical skills, and excellent communication skills.

Preferred:
- Hyperion Pillar, SPSS or equivalent, SQL

SCOPE INFORMATION

# Direct Reports:

# Indirect Reports:

Budgetary Responsibility: Entire Plan budget

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.
- Travel required and must be able to travel on common carriers and to adhere to AMERIGROUP’s travel policies.
- Standing and sitting for long periods of time.
- Data Entry using repetitive motions of fingers and forearms.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Vice-President-Finance-Position-located-in-Kansas-Job/2556788/255678825567882013-07-18AmerigroupFinancefull-timeUSDstarting0BS, ,
Job ID 2013-22669 # Positions 1
Location US-NATIONWIDE
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 4/24/2013
Additional Locations ..

More information about this job:
Summary:

The HCE Analyst II is responsible for collecting, analyzing and interpreting health care data, including claims, clinical, member, and provider information performing professional level work that requires processing and interpreting more complex, less clearly-defined issues. Works on problems of moderate scope to create actionable information and effectively communicate results that support effective and efficient healthcare findings to customers.

Responsibilities:

1. Responsible for conducting intermediate level data management.

2. Develops and executes moderate to complex programs to produce reporting deliverables, including file extracts.

3. Performs business requirements gathering and analysis.

4. Collaborates with internal and external partners and organizations to understand data needs and design analytic studies to answer business and research questions.

5. With limited supervision structures intermediate level project plans for analytical projects.

6. With limited supervision interprets results and prepares findings for presentation to internal and external audiences.

7. Conducts quality reviews on own and peers’ work products.

8. Integrates feedback to drive continuous improvement and grow subject matter knowledge.

9. Applies intermediate level financial, clinical and/or operational analysis.

10. Monitors and identifies patterns and trends of concern and communicates to business owner. Elevates and presents to HCE management as necessary.

11. Adheres to all applicable compliance standards.

12. Other job duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Finance, Economics, Business Administration or a related discipline or equivalent experience.

Years and Type of Experience Required:

Required:
- Minimum of three years of related work experience in data analysis, report development and/or application development/implementation.

Preferred:
- Minimum of one year healthcare industry experience, preferably in managed care.
- Minimum of one year experience with government programs.

Language Skills

Required:
- English

Technical Competencies

Computer Skills and Office Equipment
- Proficiency with Microsoft Office products, Excel in particular.
- Programming language such as SQL or SAS preferred.

Communication Skills

Verbal, Written and Telephonic
- Able to provide professional and appropriate written and verbal information to internal and external customers.
- Strong customer service/relationship skills and ability to work effectively and multi-task in a fast paced environment with shifting priorities.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability/Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track. Surfaces problems and issues before projects get derailed.

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 procedure.

ermIT
]]>http://www.amerigroup-jobs.com/job/Healthcare-Economics-Analyst-II-Developer-%28position-located-in-Virginia-Beach%29-Job/2564573/256457325645732013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BS, ,
Job ID 2013-22686 # Positions 1
Location US-NATIONWIDE
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 4/25/2013
Additional Locations ..

More information about this job:
Summary:

In accordance with the Project Management Body of Knowledge (PMBOK) and PMI standards, independently directs the highest priority projects or one larger high priority project which requires considerable resources and high levels of functional integration. Responsible for all aspect of the project over the entire life. Responsible for system scope and project objectives, as well as the role and function of each project team member or functional area, to effectively manage the activities of the team. Responsible for assembling project team, assigning individual responsibilities, identifying appropriate resources needed, and developing schedule to ensure timely completion of project. Takes projects from original concept through final implementation. Interfaces with all areas affected by the project including end users, distributors, and vendors. Ensures adherence to quality standards and reviews project deliverables.

Responsibilities:

1. Directs changes to the project scope, project schedule, and project costs using appropriate verification techniques in order to keep the project plan accurate, updated, reflective of authorized project changes as defined in the change management plan, and facilitate customer acceptance.

2. Directs and executes the tasks as defined in the project plan in order to achieve the project goals.

3. Works with business leaders to ensure resource availability, workload and performance as well as to drive project vision through effective risk management and manage changes through a defined change management system.

4. Mentors junior project managers, coordinators and business analysts.

5. Communicates to ensure a common understanding by setting expectations in accordance with the Project Plan, in order to align the stakeholders and team members.

6. Analyzes and records detailed customer requirements, constraints, and assumptions with stakeholders in order to establish the project deliverables, using requirement-gathering techniques (e.g., planning sessions, brainstorming, focus groups) and the project charter.

7. Measures project performance using appropriate tools and a technique in order to monitor the progress of the project, identify and quantify any variances, performs any required corrective actions, and communicate to all stakeholders.

8. Implements the approved actions and workarounds required to mitigate project risk events in order to minimize the impact of the risks on the project.

9. Documents high-level risks, assumptions, and constraints using historical data and expert judgment in order to understand project limitations.

10. Manages team performance by building team cohesiveness, leading, mentoring, training, and motivating in order to facilitate cooperation, and ensure project efficiency.

11. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors Degree or equivalent.

Years and Type of Experience Required:

Required:
- 6-10 years Project Management/Project Coordination Experience.

Preferred:
- Health care insurance industry experience.
- Business analysis and process improvement experience.
- MS Project, Outlook, PowerPoint and Visio experience.
- Familiarity with data collection and analysis techniques.
- Survey tools experience, e.g. Survey Monkey.

Certifications or Licensures

Required:
- PMI PMP (Project Management Professional) or ability to obtain within first six months.

Preferred:
- IIBA CCBA (Certification of Competency in Business Analysis) or Six Sigma Green Belt Certification.

Language Skills

Required:
- English

Technical Competencies

Project Management - Advanced
- Ability to independently lead large, complex projects in accordance with Project Management Body of Knowledge (PMBOK) and Project Management Institute (PMI) standards. Solid understanding of process improvement and project management including tools and techniques, critical path method, program evaluation and review technique, resource balancing and cost estimating. Ability to clarify and interpret the relationships between a system and its component parts.

Industry Knowledge & Familiarity - Advanced
- Deep understanding of the healthcare industry and government insurance programs, e.g. Medicare, Medicaid, CHIP and LTC.

Computer Skills and Office Equipment - Advanced
- Ability to use software and hardware of a computer to complete certain moderately-complex to complex tasks. Able to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key. Use of internet, familiarity with SharePoint sites. Ability to review and draft correspondence in email system and word processing systems.
- Ability to use project management and related software, e.g. MS Project, VISIO, SharePoint. Ability to use software for data analysis, reporting and sharing of information to solve problems. Ability to create and manipulate spreadsheets (i.e., data entry and format cells).

Behavorial Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

SCOPE INFORMATION

# Direct Reports: 0

Project Budget Range: $500,000 to $5 Million

Project Team Size: 10 - 20

Project Duration: 12 – 18 months

Project Timeline: Aggressive

Project Risk: High

# of System Interfaces: Multiple

#of Geographical Regions: 2 Plus

# of Functional Disciplines/Stakeholders: Multiple

# of Sub-Projects: Multiple

Level of Innovation / Means to Achieve Goals: Primarily Existing / Minor Modifications

Project Scope Definition: Moderately Defined

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Project-Manager-III-%28position-located-in-Virginia-Beach%29-Job/2566932/256693225669322013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BS, ,
Job ID 2013-22683 # Positions 1
Location US-NATIONWIDE
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 4/25/2013
Additional Locations ..

More information about this job:
Summary:

In accordance with the Project Management Body of Knowledge (PMBOK) and PMI standards, independently leads multiple projects or one larger project. Responsible for all aspect of the project. Responsible for familiarity with system scope and project objectives, as well as the role and function of each project team member or functional area, to effectively manage the activities of the team. Responsible for assembling project team, assigning individual responsibilities, identifying appropriate resources needed, and developing schedule to ensure timely completion of project.

Responsibilities:

1. Execute the tasks as defined in the project plan in order to achieve the project goals.

2. Manage changes to the project scope, project schedule, and project costs using appropriate verification techniques in order to keep the project plan accurate, updated, reflective of authorized project changes as defined in the change management plan, and facilitate customer acceptance.

3. Assists senior Project Managers and business leaders to ensure resource availability, workload and performance as well as to drive project vision through effective risk management and manage changes through a defined change management system.

Assist in the mentoring of junior project managers, coordinators and business analysts.

4. Measure project performance using appropriate tools and techniques in order to monitor the progress of the project, identify and quantify any variances, perform any required corrective actions, and communicate to all stakeholders.

5. Communicate to ensure a common understanding by setting expectations in accordance with the Project Plan, in order to align the stakeholders and team members.

6. Record detailed customer requirements, constraints, and assumptions with stakeholders in order to establish the project deliverables, using requirement-gathering techniques and the project charter.

7. Conduct a kick-off meeting with all key stakeholders in order to announce the start of the project and review the overall project plan and gain consensus.

8. Implement the approved actions and workarounds required to mitigate project risk events in order to minimize the impact of the risks on the project.

9. Improve team performance by building team cohesiveness, leading, mentoring, training, and motivating in order to facilitate cooperation, ensure project efficiency.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree or equivalent experience

Years and Type of Experience Required:

Required:
- 3 - 5 years Project Management/Project Coordination Experience.

Preferred:
- Health care insurance industry experience.
- MS Project, Outlook, PowerPoint and Visio experience.
- Familiarity with data collection and analysis techniques.
- Survey tools experience, e.g. Survey Monkey.

Certifications or Licensures

Required:
- Strongly preferred PMI CAPM (Certified Associate in Project Management) or ability to obtain within first six months.

Preferred:
- PMI PMP (Project Management Professional)

Language Skills

Required:
- English

TECHNICAL COMPETENCIES

Project Management - Intermediate
- Ability to independently lead small to medium projects or one large project in accordance with Project Management Body of Knowledge (PMBOK) and Project Management Institute (PMI) standards. Solid understanding of process improvement and project management including tools and techniques, critical path method, program evaluation and review technique, resource balancing and cost estimating. Ability to clarify and interpret the relationships between a system and its component parts.

Industry Knowledge & Familiarity - Intermediate
- Solid understanding of the healthcare industry and government insurance programs, e.g. Medicare, Medicaid, CHIP and LTC.

Computer Skills and Office Equipment - Intermediate
- Ability to use software and hardware of a computer, e.g. Outlook, PowerPoint, etc., to complete certain moderately complex tasks. Able to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key. Use of internet, familiarity with SharePoint sites. Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to solve problems. Ability to create and manipulate spreadsheets (i.e., data entry and format cells).

SCOPE INFORMATION

# Direct Reports: 0

Project Budget Range: $0 - $1 million

Project Team Size: 6-10

Project Duration: 1 – 11 months

Project Timeline: Moderately Aggressive

Project Risk: Medium

# of System Interfaces: Multiple

#of Geographical Regions: 2

# of Functional Disciplines/Stakeholders: 1-5

# of Sub-Projects: Multiple

Level of Innovation / Means to Achieve Goals: Primarily Existing / Minor Modifications

Project Scope Definition: Fairly Defined

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Project-Manager-II-%28position-located-in-Virginia-Beach%29-Job/2566933/256693325669332013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BS, ,
Job ID 2013-22726 # Positions 3
Location US-NATIONWIDE
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/2/2013
Additional Locations ..

More information about this job:
Summary:

Independently designs, develops, modifies, debugs and evaluates programs for functional and operational areas. Receives technical guidance only on unusual or complex problems or issues. 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.

Responsibilities:

1. Develops program logic for new applications or analyzes and modifies logic in existing applications. Identifies and creatively resolves complex problems.

2. Modifies moderate to complex application programs from detail specifications.

3. Applies a comprehensive knowledge and works independently to code, test, debug, document, implement and maintain software applications.

4. Creates a complex design document through the assessment of requirements. Assesses alternatives to different designs and selects best solution to fit business needs.

5. 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.

6. Assists in ensuring that system improvements are successfully implemented. Resolves complex design issues utilizing software development lifecycle and development methods.

7. Develops multiple, modular objects and the messaging interface between objects to create a complex software package. Reuses objects and creates object inventories.

8. Performs complex queries and updates of tables. Performs complex data modeling and database design with minimal oversight.

9. Defines requirements for application infrastructure including scalability, reliability, availability and serviceability and the trade-offs of each.

10. 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.

11. Performs moderate to complex application administration and support.

12. Performs other duties as assigned/requested.

Qualifications:

EDUCATION REQUIRED

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:
- Five years relevant work experience.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Advanced
- Thorough understanding of the core IT applications and systems and the inter-relationship among them. Advanced proficiency with all applicable company supported software applications and the associated infrastructure.
- Ability to use hardware and software of a computer to complete certain complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Proficiency in a windows environment to include navigation skills and use of internet. Ability to review and draft correspondence in email and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Programming Analysis - Advanced
- Thorough understanding of data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Understanding of referential integrity, locking and transaction processing. Understands impact of data modeling decision on system performance and resource usage. Knowledge of current and evolving application architecture trends to include infrastructure, software, database, networks and their interdependencies. Thorough understanding of Object oriented analysis and design. Thorough understanding of programming languages such as Objective C, Java, etc. Thorough understanding of environments used when programming such as .NET container or J2EE application server. Understands the strategic alignment of IT solutions with business objectives.

Project Management - Advanced
- Ability to develop and implement moderately complex project plans, and manage a project with supervision.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

D: JR

CB1

ermIT
]]>http://www.amerigroup-jobs.com/job/ITS-Programmer-Analyst-III-Data-Warehouse-Job/2578752/257875225787522013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BS, ,
Job ID 2013-22980 # Positions 1
Location US-VA-Virginia Beach
Search Category Health Care Administration
Type Regular Full-Time (30+ hours) Posted Date 5/30/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for supporting Medicare Marketing department data needs and reports used for sales activity, enrollment processing and tracking. Provide comprehensive data and reports used in the analysis of the approved covered service area. Provide support and facilitate communication through operational, administrative, project coordination and reporting responsibilities..

Responsibilities:

1. Provide data management support utilizing Salesforce.com (CRM System) as needed, to include importing leads into Salesforce.com; updating Salesforce.com with disenrollment data, tracking advertising and direct mail results, tracking sales activity: productivity metrics, sales statistics, and enrollment forecast, and producing reports as needed.

2. Maintain enrollment reviews, tracking systems and internal processes to ensure timely and accurate processing of membership applications.

3. Develop and manage information flow regarding reporting requirements as it pertains to sales and marketing.

4. Provide reports as needed or requested of scheduled events.

5. Track individual Event Attestations and assist in completion of CMS Event Calendar; prepare routine reports related to the Plan’s event and enrollment marketing strategies.

6. Ensure sales and marketing related policies are updated as needed and in compliance with CMS guidelines.

7. Works in conjunction with plan departments to assist/ensure appropriate material updates, to include priority member and provider materials.

8. Responsible for maintaining supply inventory, including brochures and give away items.

9. Other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors Degree in related field (i.e., Business Administration, Marketing, Finance…etc.) or equivalent experience.

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:
- Proficient with Microsoft Office, to includeExcel, PowerPoint, Word, and Outlook.

Preferred:
- Proficient with SharePoint, SalesForce.com, Microsoft Access, and/or 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.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Nashville-Marketing-Coordinator-Medicare-Job-TN-37201/2629931/262993126299312013-07-18AmerigroupHealth Care Administrationfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-23011 # Positions 1
Location US-VA-Virginia Beach
Search Category Finance
Type Regular Full-Time (30+ hours) Posted Date 6/3/2013
Additional Locations ..

More information about this job:
Summary:

Under general supervision is responsible for supporting Finance management in performing the day-to-day operations of financial planning and analysis. Utilizes understanding of budgeting and forecasting procedures to support analysis and execution of the administrative expense and/or capital forecasts and budgets, for areas of direct responsibility. Provides feedback to management regarding suggestions for cost savings opportunities that allows for the efficient and most effective distribution of financial resources.

Responsibilities:

1. Compiles budget and forecast estimates and proposals for completeness; accuracy; and conformance with established procedures, regulations, and organizational objectives. Maintains confidentiality of all corporate and financial data.

2. Prepare budget and forecast documents, and provide accurate and timely information to management.

3. Support business owners with development of SG&A budgets, forecasts and staffing projections, as well as, subsequent variance analyses and reporting. Develops collaborative working relationships with business owners and other corporate customers.

4. Support business owners in the completion of proposals in terms of the organization’s priorities and financial resources and work with them to obtain justification then prioritize and devise possible alternatives when incremental funding sources limited.

5. Periodic reporting and monitoring of budget vs. actual results explaining variations and identifying revised procedures program cuts or reallocation of availability budgeted funds as well as inclusion of identified risks and opportunities in future forecasts and budgets.

6. Create reports for management analysis using Excel, Hyperion reports and PeopleSoft.

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor of Science degree accounting, finance, business with concentration in accounting, public finance, statistics; other degree acceptable with related experience.

Years and Type of Experience Required:

Required:
- Less than 2 years.

Certifications or Licensures

Preferred:
- CPA

Language Skills

Required:
- English

Functional Competencies
- Basic knowledge of generally accepted accounting principles.
- Basic knowledge of financial reporting documents that communicate financial information including income statement, balance sheets, and cash flow reports.
- Basic knowledge in the use of financial operating statements to explain business results.
- Experience using spreadsheet, database, data-mining, graphics, and word-processing software.
- Experience in the preparation of operational planning through analysis of statements and application of quantitative, numeric and quantitative analytic skills.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 0

Budgetary $ Responsibility: Up to $950M annually SG&A and/or $100M capital.

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.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Budget-Analyst-I-Job-VA-23450/2636862/263686226368622013-07-18AmerigroupFinancefull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-23014 # Positions 1
Location US-VA-Virginia Beach
Search Category Human Resources
Type Regular Full-Time (30+ hours) Posted Date 6/3/2013
Additional Locations ..

More information about this job:
Summary:

Under general direction, responsible for day-to-day administration of policies and programs covering several or all of the following: recruiting, compensation and benefits, training, employee relations. Partners with assigned client groups to gain understanding of client's business in order to effectively support, propose and lead initiatives that support business unit objectives and success.

Responsibilities:

1. Partners with assigned client groups to gain understanding of client's business in order to effectively support, propose and lead initiatives that support business unit objectives and success.

2. Act as advisor and coach on human resources issues such as associate issues and questions, managing change and supporting a positive work environment.

3. Partner with assigned business unit to support associate development and establish development plans, career paths and retention programs.

4. Assess and make recommendations for organizational structure based on talent and organizational goals.

5. Design and implement strategies to support the business goals and culture through initiatives in diversity and leadership development including training, performance management, succession planning.

6. Conduct timely investigations into complaints of ADA, EEO, Workplace Harassment and other associate concerns.

7. Conduct recruitment activities including identification and selection of suitable candidates to fill open positions in conjunction with recruiting staff and/or consultants. Provide salary recommendation for potential hires and extends employment offers to qualified/selected candidates. Manage internal applicant process and provide feedback/follow-up to associates regarding application status.

8. Provide consultation to management in regards to performance reviews, compensation changes/adjustments, merit increases and promotional increases for consistency and compliance with company policy and legal considerations.

9. Facilitate New Hire Orientation sessions to review Company expectations/ guidelines, as well as Corporate Policies and Procedures.

10. Implements and manages the coordination of Human Resources programs, policies and systems as assigned.

11. Other duties as assigned.

Qualifications:

EDUCATION REQUIRED

Education

Required:
- Bachelor’s degree in related field or equivalent work experience.

Years and Type of Experience Required:

Required:
- Minimum 5 years of related experience

Specific Technical Skills

Required:
- Excellent computer skills including Microsoft Office Suite

Preferred:
- Experience working with PeopleSoft

Certifications or Licensures

Preferred:
- PHR or SPHR

Other:

Required:
- Strong Employee Relations background and knowledge to include: federal and state employment laws, NLRA, FLSA, EEO, FMLA laws, etc. required.
- Comprehensive knowledge of compensation, benefits administration, employment and HR administration.
- Ability to assess and develop solutions for organizational development and training needs.
- Excellent verbal and written communication skills, especially giving and receiving feedback.
- Strong organizational and analytical skills.
- Provide high level of customer service.
- Strong interpersonal skills and ability to use tact and diplomacy.
- Ability to maintain confidentiality.
- Strong presentation skills.
- Dedicated team player, who demonstrates initiative and independence.
- Proven problem solving and negotiation skills.
- Must be flexible; able to handle multiple projects and changing priorities.
- High energy and a positive can-do attitude.
- Previous experience in working within a highly-matrixed environment. Ability to deliver by managing through others.
- Appreciation of cultural diversity and sensitivity towards target population.

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.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Manager-Human-Resources-Job-VA-23450/2636863/263686326368632013-07-18AmerigroupHuman Resourcesfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-23019 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 6/4/2013
Additional Locations ..

More information about this job:
Summary:

Under general direction, designs, develops, modifies, debugs and evaluates programs for functional and operational areas on less complex projects with limited scope or provides support for larger projects under the review of senior team member or supervisor. 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. Entry level position for associates who have had sufficient educational background and/or experience to qualify them to start in applications programming.

Claims processing experience is a plus and experience with Macro Express is preferred.

Responsibilities:

1. Performs routine assignments to develop program logic for new applications or analyzes and modifies logic in existing applications.

2. Follows established procedures to modify application programs from detailed specifications.

3. Follows standard practices to code, test, debug, document, implement and maintain software applications.

4. Reads and interprets design documents. Creates simple design documents.

5. Reads, interprets, creates and maintains simple conceptual, logical and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

6. Assists in ensuring that system improvements are successfully implemented. Resolves simple to moderately complex design issues utilizing software development lifecycle and development methods.

7. May develop multiple, modular objects and the messaging interface between objects to create a moderately complex software package.

8. Performs complex queries. Performs simple database updates.

9. Ensures compliance and requirements of current license and support agreements are met. May obtains vendor quotes and validates invoices.

10. Performs basic application administration and support.

11. Performs other duties as assigned/requested.

Qualifications:

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:
- Entry level position for associates who have had sufficient educational background and/or experience to qualify them to start in applications programming.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Basic
- Basic understanding of core IT applications and systems and infrastructure associated with supported applications.
- Ability to use hardware and software of a computer to complete certain simple tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Proficiency in a windows environment to include navigation skills and use of internet. Ability to review and draft correspondence in email and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Programming Analysis - Basic
- Ability to understand and adhere to existing configuration management procedures. Understands data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Understands Object oriented analysis and design. Understands programming languages such as Objective C, Java, etc. Understands environments used when programming such as .NET container or J2EE application server. Basic knowledge of technology trends.

Project Management - Basic
- Basic understanding of project management concepts.

Behavioral Competencies:

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

Other:
- 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 identify problems and develop satisfying solutions.
- Demonstrates motivation and innovation for self-improvement.
- Demonstrates basic understanding of healthcare industry.
- Demonstrates knowledge of how position is related to unit/team within a department.
- Able to participate in teams as a strong team participant.

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Programmer-Analyst-I-Job-VA-23450/2640298/264029826402982013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22732 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/2/2013
Additional Locations ..

More information about this job:
Summary:

Independently designs, develops, modifies, debugs and evaluates programs for functional and operational areas. Receives technical guidance only on unusual or complex problems or issues. 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.

Responsibilities:

1. Develops program logic for new applications or analyzes and modifies logic in existing applications. Identifies and creatively resolves complex problems.

2. Modifies moderate to complex application programs from detail specifications.

3. Applies a comprehensive knowledge and works independently to code, test, debug, document, implement and maintain software applications.

4. Creates a complex design document through the assessment of requirements. Assesses alternatives to different designs and selects best solution to fit business needs.

5. 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.

6. Assists in ensuring that system improvements are successfully implemented. Resolves complex design issues utilizing software development lifecycle and development methods.

7. Develops multiple, modular objects and the messaging interface between objects to create a complex software package. Reuses objects and creates object inventories.

8. Performs complex queries and updates of tables. Performs complex data modeling and database design with minimal oversight.

9. Defines requirements for application infrastructure including scalability, reliability, availability and serviceability and the trade-offs of each.

10. 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.

11. Performs moderate to complex application administration and support.

12. Performs other duties as assigned/requested.

Qualifications:

EDUCATION REQUIRED

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:
- Five years relevant work experience.

Language Skills

Required:
- English

Technical Competencies

Computer Hardware, Software and Applications / Office Equipment - Advanced
- Thorough understanding of the core IT applications and systems and the inter-relationship among them. Advanced proficiency with all applicable company supported software applications and the associated infrastructure.
- Ability to use hardware and software of a computer to complete certain complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Proficiency in a windows environment to include navigation skills and use of internet. Ability to review and draft correspondence in email and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Programming Analysis - Advanced
- Thorough understanding of data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Understanding of referential integrity, locking and transaction processing. Understands impact of data modeling decision on system performance and resource usage. Knowledge of current and evolving application architecture trends to include infrastructure, software, database, networks and their interdependencies. Thorough understanding of Object oriented analysis and design. Thorough understanding of programming languages such as Objective C, Java, etc. Thorough understanding of environments used when programming such as .NET container or J2EE application server. Understands the strategic alignment of IT solutions with business objectives.

Project Management - Advanced
- Ability to develop and implement moderately complex project plans, and manage a project with supervision.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Programmer-Analyst-III-Job-VA-23450/2578753/257875325787532013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22814 # Positions 1
Location US-NY-New York
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/10/2013
Additional Locations ..

More information about this job:
Summary:

Performs general research and analysis to support business operations. Determines best practices and suggests how to improve current practices. Develops recommendations to solve problems and issues related to business operations. Prepare presentations to report findings to a functional or project leadership. Gathers business requirements, performs first level analysis, supporting the development and testing processes of assigned functional areas. Analyzes and reports on moderately complex business problems to be solved with automated systems or other resources.

Responsibilities:

1. Perform requirements gathering, analysis, and process and data flow diagramming for simple processes of moderate complexity.

2. Make recommendations for the Resolution of moderately complex design and functional area organizational issues utilizing department resources, business development lifecycle and development methods and software applications.

3. Read and interpret conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, and logical flow charts.

4. 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 development and/or product vendors.

5. Read and interpret a design document.

6. Develop and run moderately complex queries and reports for business analysis and trends.

7. Assist in the development of functional test plans used to verify specific system functions according to actual requirements and established guidelines.

8. Function as a liaison for IT and the business and other cross functional resources and departments.

9. Manage multiple priorities.

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience in a Business Analyst role is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Three years experience in business analysis or functional analysis role.

Preferred:
- Health care industry experience.

Certifications or Licensures

Preferred:
- CCBA certification (Certification of Competency in Business Analysis)

Language Skills

Required:
- English

Depending on the business area for a specific position, competency in one or more of the following may be Required:

Technical Competencies
- Demonstrate a basic understanding of core applications and systems.
- Demonstrate proficiency with all applicable company supported software applications.
- Able to provide professional and appropriate written information to internal and external customers.
- Able to initiate conceptual ideas with practical applications.
- Basic knowledge of the inter-relationship among various managed care operational areas.
- Basic knowledge of current technology trends.
- Able to develop and maintain customer relationships.
- Able to identify, analyze, and solve problems and to work with teams to solve problems.
- Able to develop and implement basic project plans.

Computer Skills and Office Equipment - Intermediate
- Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data. Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.

Spreadsheet Utilization and Management - Intermediate
- Proficient in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools.

Database Utilization and Database Management - Novice

Systems - Intermediate

Understanding of system's utilization and proficient retrieval of information and processing of the following systems:
- NetworX/Facets – build pricing based on provider contracts using Facets applications. Build benefit plans based on State regulations using Facets benefit applications.
- MACESS – contracts and claim images are stored. MACESS Workflow tool for contract life-cycle.
- Software products from Ingenix for prospective payment system (PPS) – pricing.
- Clearquest is used to track projects –knowledge and familiarity using a project inventory tracking system.

Applications/Tools - Intermediate

Ability to leverage available tools such as:
- TOAD, UltraEdit, Microsoft Project, Microsoft query analyzer SQL mgr, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity - Basic
- General healthcare, who are our providers (hospitals phy ofc, ancil) who are payors (insurance companies),
- High level claims process, knowledge of general industry how it works.
- More specific knowledge around reimbursement methodology, fee schedules. Per case, per diem, DRG, % of charges, those terms. HIPAA.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping DRG codes, place of service codes (POS),

Government Programs Specific Knowledge
- Medicare Medicaid programs, CHIP and LTC.
- Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Gather and Document Requirements - Intermediate
- Ability to prepare simple to moderately-complex requirements documents. Ability to facilitate requirements gathering including determining the most efficient and effective way to capture the requirements, and managing kick off and subsequent status meetings. Ability to manage timelines and due dates. Ability to recognize and understand business changes that impact requirements and incorporate changes into documentation. Ability to read and re-read requirements documents multiple times while maintaining detail orientation.

Contracts - Intermediate
- Ability to read a contract and understand the operational requirements the contract creates. Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving-Analytics - Basic
- Critical thinking and problem solving methods.

Project Management - Intermediate
- Skilled in running a project utilizing standard project management tools, techniques and methodology. Keeps projects on task.

Testing - Intermediate
- Functions independently in the creation of simple to moderately-complex test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/New-York-Operations-Business-Anlyst-II-Job-NY/2592117/259211725921172013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22815 # Positions 1
Location US-NY-New York
Search Category Legal
Type Regular Full-Time (30+ hours) Posted Date 5/10/2013
Additional Locations ..

More information about this job:
Summary:

Under general direction:
- Performs project management of Compliance deliverables in collaboration with the Plan Compliance Officer (PCO) including annual and refresher education, external document requests and the annual work plan(s);
- Manages the Collateral Materials Approval and Regulatory Alert processes and provides technical assistance to Plan Compliance Officers (PCO) on compliance deliverables.
- Performs marketing compliance training, monitoring, and surveillance to ensure compliance with state contract requirements, and state and federal marketing requirements.
- Operates as the health plan HIPAA liaison in collaboration with the Member Privacy Unit.

Supports Amerigroup’s compliance obligations, including, but not limited to, the regulatory and contractual obligations imposed by state and federal regulatory bodies. Serves as a liaison with internal and external reviewers of compliance program activities and monitors and facilitates identified business owner actions to develop or support compliant activity.

Performs project management of Compliance deliverables in collaboration with the Plan Compliance Officer (PCO) including annual and refresher education, external document requests and the annual work plan(s);

This position sits in our NYC office. This is not a telecommuting position.

Responsibilities:

1. Maintain subject matter expertise on state and federal compliance requirements in order to develop and/or update annual and refresher education content for all associates. Project manages the development, distribution and completion of annual and refresher education training.

2. Operate as the project manager for coordination, collection and distribution of informational material for external and internal reviewers.

3. Serve as primary OBE representative on company subcommittees such as the Vendor Selection Oversight subcommittee.
- Act as a key OBE contact for multi-departmental subcommittees and serve as subject matter expert for compliance questions that may arise.
- Develop and maintain productive working relationships with committee members, and key internal and external reviewers.

4. Research and identify trends, as appropriate, on health plan member complaints and call surveys. Coordinate with OBE staff to provide feedback to business owners on potential process improvement activities.

5. Research and monitor functional business owner assessment and completion of action plans, as applicable, for Regulatory Alerts.
- Ensure Regulatory Alerts impact assessments are completed timely; and
- Identify/attain agreement on business owner accountability for deliverables arising from the Regulatory Alerts;

6. Lead/co-lead the maintenance and operation of OBE databases used to identify and track company response to potential compliance issues.
- Develop and maintain a standard reporting schedule to provide updates on identified areas.; and
- Provide trending analysis on standard or ad hoc reports.

7. Support the development and implementation of annual Plan Compliance Officer Work plans.
- Assist in the development of work plan reporting templates for use by all Plan Compliance Officers.
- Monitor Plan Compliance Officer completion of work plan activities through maintenance and review of the work plan database and applicable dashboards.

8. Manage monthly exclusion screening review of all Amerigroup associates and non-provider vendors by confirming OIG and GSA exclusion screening status for each existing associate and non-provider vendor.

9. Review and assess collateral documents for compliance with market or product specific guidelines as a primary reviewer in the Collateral Material Approval Process.

10. Manage and coordinate the activities of Plan Compliance Officer support staff as those activities relate to OBE driven activities, provide leadership and motivation by establishing clear expectations and communicating specific performance feedback. Provide training and support to PCO team members, as appropriate.

11. Perform other duties as assigned/requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree or equivalent combination of education and experience required.

Years and Type of Experience Required:

Required:
- Minimum of 5 years relevant work experience with at least 2 years of managed care industry experience and 1 year of leadership/management experience.

Specific Technical Skills

Required:
- Intermediate level of MS Office skills; specifically MS Word and Exce.
- Strong Internet research skills.

Preferred:
- Experience with Microsoft Access database development and maintenance.
- Experience with legal/regulatory databases or search engines.

Other:

Required:
- Strong analytical and organizational skills.
- Strong verbal and written communication skills.
- Ability to work independently – to initiate and coordinate activities to meet team and department’s goals and objectives.
- 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 and present company position in understandable and unambiguous manner.
- Ability to identify, prioritize and resolve problems - recommending options and negotiating/implementing 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 toward target population.

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.

ermCorp
]]>http://www.amerigroup-jobs.com/job/New-York-Manager%2C-Compliance-NY-%28Business-Ethics%29-Job-NY/2592119/259211925921192013-07-18AmerigroupLegalfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22882 # Positions 2
Location US-NY-New York
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/16/2013
Additional Locations ..

More information about this job:
Summary:

Provide manage care and services to members. Coordinate services/health care services by facilitating, scheduling, and arranging a variety of treatment and services. Complete authorizations, correspondence, and manages phone queues within the department.

Responsibilities:

1. Coordination, authorization, fulfillment, reporting, monitoring and tracking of services.

2. Responsible for responding to inquiries from Members and Providers to clarify benefits, provide member education and member referrals.

3. Establish working relationships with referral sources, providers, community agencies and vendors to proactively coordinate access to services.

4. Maintains and supports documentation, logs and data entry to monitor activity and/or outcomes related to care coordination services in an accurate and timely manner.

5. Documents all pre-certification and authorization requests as well as member encounters utilizing the appropriate systems and resources.

6. Initiates contact with assigned individuals/personal representatives, guardians and providers to determine member’s response to services.

7. Completes initial screening and makes outreach calls to members. Performs assessments under the supervision of a nurse/clinician, as appropriate.

8. Refers members to case management or other clinical programs as indicated.

9. Collaboratively works with other departments to meet member needs and support departmental business initiatives.

10. Completes department letters or other correspondence, as assigned.

11. Ensure compliance with all department timelines including telephone service standards and turn-around times.

12. Manages pended claim, authorization, or error reports as assigned.

13. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associate Degree or equivalent work experience.

Preferred:
- Bachelors degree.

Years and Type of Experience Required:

Required:
- Minimum of 2 years working in a Health Services field.

Preferred:
- MCO/ Health Insurance Experience.
- Medicaid/Medicare.

Language Skills

Required:
- English

Preferred:
- Bi-lingual

Functional Competencies
- Ability to use Microsoft Office (e.g. Outlook, PowerPoint, excel etc.) to complete certain simple tasks and use of basic office equipments.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key. Use of internet, familiarity with SharePoint sites.
- Knowledge of Medical Terminology preferred.
- Good communication skills, both written and verbal; ability to respond to customers from internal/external in an understandable and unambiguous manner.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Case-Specialist-Utilization-Management-Job-NY/2602081/260208126020812013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22665 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/16/2013
Additional Locations ..

More information about this job:
Summary:

The Manager of Appeals and Grievances leads the regulatory compliance and operations activities of AMERIGROUP’s Medical Necessity Appeals and Complaints (Grievances) process and tracking. The Manager provides expertise and leadership for AMERIGROUP’s regulatory/contractual obligations of the multiple state regulatory bodies. Requires frequent monitoring and problem solving such as work flows, electronic systems to manage these processes and implementation of solutions 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. CB1

Responsibilities:

1. Manage the Medical Necessity Appeals (MNA) and Complaints process and reporting:
- Provide management and leadership with information and tools for strategic planning and decision making for Amerigroup complaints and medical necessity appeals .
- Provide expertise as the AGP corporate subject matter expert with Health Plans and corporate entities and Regulatory for complaint tracking and MNA. · Develop and maintain productive working relationships with key regulators and Health Plan contacts that leads to a mutual accountability to benefit company-wide operations and activity.
- Subject matter expert/advisor on MNA and complaints requirements and programs, including state-specific/federal requlations and NCQA requirements.
- Oversight of all MNA activity including MNA external reviews, including State Fair 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 AGP-wide business activity and operations.

3. Develop and maintain resource tools for internal education, and compliance assessments.

4. Work with AGP Compliance Dept. to lead AGP and vendor preparations for performance assessments, and internal delegation and compliance 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. Submissions of reports for MNA and complaints/grievances to the appropriate committees and internal departments.

6. Provide feedback on regulatory filings and member correspondence pertaining to MNA and complaint management.

7. Advises AGP markets and corporate groups on the definition of MNA and complaints eliminating grey areas of confusion with provider disputes and MNA. Uses clinical expertise in problem solving for complaint and MNA follow-up needs.

8. Oversee market expansions and new market activities from an operational perspective, developing processes and policies to support the RFP, regulations, or EQRO requirements.

9. Provide management of associates with motivational environment 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.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree. Experience in lieu of degree is acceptable
- Experience with medical necessity appeals process and regulation.

Preferred:

Bachelor’s degree in nursing. Registered Nurse with managed care experience with appeals and grievances process.

Years and Type of Experience Required:

Required:
- 5 years of relevant work experience in the healthcare industry, preferably a managed care environment.
- 3 years of leadership and management experience.

Preferred:
- 1-2 years experience managing appeals and/or complaint processes for large company.
- Extensive knowledge of accreditation requirements for MNA and complaints, including NCQA and AAAHC.
- Extensive knowledge of federal and state managed care regulations.

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.

Certifications or Licensure

Preferred:
- Registered Nurse (RN).

Other:

Required:
- Strong analytical and organizational skills.
- Excellent verbal and written communication skills.
- Ability to analyze, interpret, and summarize contracts, regulations, policies/procedures, reports and legal documents.
- Ability to respond to questions/concerns from internal customers, External Quality Review Organizations (EQRO) 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

# Direct Reports: 2-5

# 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.

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Mgr-Appeals-&Grievance-Quality-Management-Job-NY/2602085/260208526020852013-07-18AmerigroupNursingfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22892 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/16/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

2. Predicts and plans for patient’s needs from pre-admission, through acute and sub acute 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. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

7. 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.

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

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Nursing Diploma.
- Associate’s Degree in related Health/Nursing field.

Preferred:
- Bachelor’s Degree in related Health/Nursing field.

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of 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.

Certifications or Licensures

Required:
- RN
- Must possess a valid driver’s license and access to a motor vehicle.

Preferred:
- Certified Professional Healthcare Management

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/New-York-Utilization-Manager-RN-Inpatient-Job-NY/2604268/260426826042682013-07-18AmerigroupNursingfull-timeUSDstarting0BSNew York, NY, US
Job ID 2013-22734 # Positions 1
Location US-VA-Virginia Beach
Search Category Sales & Marketing
Type Regular Full-Time (30+ hours) Posted Date 5/6/2013
Additional Locations ..

More information about this job:
Summary:

The Writer, Communication Services develops concepts and writes copy for Communications collaterals in a variety of formats. Works with VP, Communications, Director/Manager Level Writer, Communications and Art Director/Graphic Designer to write, edit and proofread printed and online materials, before and after design process. Submits all documentation and forms to obtain necessary approvals of text from internal Company business owners and government regulatory agencies.

Responsibilities:

1. Works directly with appropriate staff to ascertain scope of project and analyzes needs of target audience.

2. Writes, edits, proofreads and revises internal and/or external Communications materials, including brochures, RFP sections, web site content, flyers, collaterals, newsletters, companywide emails and presentations, etc.

3. Ensures compliance with strategic initiatives, state and federal regulations to include appropriate key messaging for brand.

4. Submits collateral through the Company’s internal approval process (Collateral Material Approval Process, or CMAP), state and federal government regulatory reviews as appropriate for external audiences.

5. Works with Art Director to develop concepts for to internal and/or external customers.

6. Develops, produces and collaborates with appropriate partners (internal and external) in the writing and production of Requests for Proposals, White Papers, and related materials and projects.

7. Other Duties as Assigned.

Qualifications:

Education

Required:

Bachelor’s degree in English, Communications, Marketing or Healthcare or related field of study.

Years and Type of Experience Required:

Required:

5 years professional writing experience developing targeted communications materials, or equivalent academic experience in pursuit of a higher level degree.

Preferred:

7 years professional writing experience developing materials in healthcare/service industry preferred.

Specific Technical Skills

Required:
- Proficient in Microsoft Word, PowerPoint and Outlook; working knowledge of Excel, Project, Visio, and SharePoint.
- Excellent command of English language and proficiency in Associated Press Style guidelines.

Other

Required:
- Excellent verbal and written communications skills
- Effective management skills – organization, planning, setting goals and objectives, time management
- Effective leadership skills
- Excellent interpersonal skills
- Excellent social skills
- Thorough appreciation of cultural diversity and sensitivity toward target populations

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 conduct and participate in meetings
- Must be able to travel on common carriers and adhere to Amerigroup’s travel policies

ermSM
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Writer-Comm-Svcs-Job-VA-23450/2581110/258111025811102013-07-18AmerigroupSales & Marketingfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22733 # Positions 1
Location US-VA-Virginia Beach
Search Category Sales & Marketing
Type Regular Full-Time (30+ hours) Posted Date 5/6/2013
Additional Locations ..

More information about this job:
Summary:

The Senior Graphics Designer is responsible for producing a full spectrum of graphics, designs and copy layouts for print collateral used in support of external communications and/or internal design jobs. The position will lead from the graphic development perspective, and work with others in the organization to create print pieces, electronic communications and other materials as needed to promote organizational messaging. The ability to think strategically to produce effective materials and to lead projects is crucial.

Responsibilities:

1. Work with team to create and illustrate the company’s messaging graphically by designing eye catching and substantive communications for internal and external partners.

2. Responsible for communications graphic layout. Manage and approve print production and print specifications with vendors. Ability to use computer software to format and combine text, numerical data, photographs, charts and other visual graphic elements to produce publication-ready material.

3. Determine size and arrangement of illustrative material and copy, select style and arrange layout based upon available space, knowledge of layout principals and aesthetic design concepts. 4. Produce communications and other creative print medical based on content which will be utilized by internal and external partners.

5. Develop collateral materials to be utilized by internal and external partners.

6. Excellent communication skills. Ability to work with all levels of associates. Ability to translate written and/or verbal communications into graphics.

7. Ability to write and edit materials and perform final editing and formatting of all communications for internal and external partners.

8. Other Duties as Assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- B.S. in Fine Arts or Graphics Design.

Years and Type of Experience Required:

Required:
- 5 years of graphics design experience.

Preferred:
- Advanced degree or certificate.

Specific Technical Skills

Required:
- Expert knowledge of Mac computer, Quark, Adobe Creative Suite; expertise in MS Office (Excel, Word, PowerPoint) required.
- Ability to translate written and/or verbal communications into graphics.
- Use computer software to format and combine text, numerical data, photographs, charts and other visual graphic elements to produce publication-ready material.
- Strong communication and interpersonal skills.
- Ability and comfort working with clients at the executive level within the organization.
- Exceptional attention to detail and standard of excellence.
- Ability to work independently and as a team member.
- Ability to think strategically to produce effective materials and to lead projects from the graphic development perspective.
- Comfortable working in a deadline-driven, fast-paced environment.

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.

ermSM
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Sr-Graphic-Designer-Job-VA-23450/2581112/258111225811122013-07-18AmerigroupSales & Marketingfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22777 # Positions 1
Location US-VA-Virginia Beach
Search Category Communications
Type Regular Full-Time (30+ hours) Posted Date 5/6/2013
Additional Locations ..

More information about this job:
Summary:

The Public Relations Specialist will provide support to a Communications team with various public relations and communication projects and tasks. This position will work collaboratively with senior leadership on the Communications team, Health Plan leadership, Consultants, Vendors and relevant business owners to promote “Real Stories,” various Company activities, Amerigroup Foundation events, corporate events and conferences across the health plans to enhance the Company’s image and brand. The Public Relations Specialist will implement the social media strategy, coordinating with department management to ensure its effectiveness and encouraging adoption of relevant social media techniques in the culture.

Responsibilities:

1. Collaborates with writers, web designers, graphic artists, developers and Subject Matter Experts (SMEs) to develop written material, collaterals, press releases, talking points, scripts, web content copy and other relevant materials to promote and inform the public and press of Company campaigns and events.

2. Creates communications strategy for prioritized health plan markets and business development markets.

3. Ownership for leveraging and highlighting Public Relations opportunities for the AGP Foundation—create corporate and health plan media advisories and press releases for each event.

4. Seeks opportunities to promote Amerigroup in our current and business development markets.

5. In collaboration with the department leaders and the external public relations company, will help manage the Amerigroup Speaker’s Bureau.

6. Assists the Public Relations team plan and conduct speaking engagements and other formal presentations with the general public, media, community groups, and employees. Research subject matter; provide support on key message development; and coordinate the development of audio and visual materials if required. Ensure communications are tailored to the audience.

7. Maintains working relationship with national, local and specialty media contacts germane to the health care industry, national business and other key outlets.

8. Strategizes and develops plan with contracted Public Relations firm, in pitching, booking, and coordinating interviews for Company spokesperson(s), executives and SMEs.

9. Supports the Company’s social media platform, internal framework, process and outreach. Providing daily management of all social properties including but not limited to Twitter, Facebook, LinkedIn and YouTube accounts based on company objectives and support for market messaging as well as other critical areas.

10. Perform other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in English, Journalism, Communications, Public Relations or other related experience in lieu of degree(s).

Preferred:
- Accredited in Public Relations (APR) designation or Accredited Business Communicator (ABC) designation.

Years and Type of Experience Required:

Required:
- Minimum three years relevant work experience.

Preferred:
- Minimum five years of related media relations experience; Health care industry and/or political experience a plus.

Language Skills

Required:
- English

Functional Competencies
- Proficient in Associated Press style writing standards.
- Ability to work independently, as a team member and collaborate with associates at all levels.
- Demonstrate sound decision-making, problem-solving, good judgment, research and presentation skills.
- Demonstrate effective verbal, written and broad communications experience with depth in media relations, issues management, and crisis communication.
- Maintain knowledge of government regulations and emerging web technology to ensure regulatory compliance.
- A creative and strategic thinker with broad public affairs and public relations experience.
- Demonstrate an enthusiasm for motivating people.
- Demonstrate analytical and persuasion/negotiation skills.
- Experience in strategic approach to communication and program development.

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.


]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Public-Relations-Specialist-Job-VA-23450/2582910/258291025829102013-07-18AmerigroupCommunicationsfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22789 # Positions 1
Location US-VA-Virginia Beach
US-TX-Houston
US-FL-Tampa
Search Category Human Resources
Type Regular Full-Time (30+ hours) Posted Date 5/7/2013
Additional Locations US-TX-Houston
US-FL-Tampa

More information about this job:
Summary:

Under general supervision, responsible for the design, development, and maintenance of training materials for new business implementations and on-going staffing initiatives to include printed and web-based materials. Contributes to the OD&T quality analysis and course evaluation processes.

Responsibilities:

1. Under general supervision, perform day-to-day instructional design duties.

2. Outline training program and determine method, sequence and instructional approach.

3. Development, content maintenance of training materials to include instructor lead training, computer based training, assessments, and on-line reference tools.

4. Contribute to the OD&T quality analysis process.

5. Independently complete scopes of work.

6. Develop and maintain positive business relationships with clients, and serve as the point of contact on individual projects.

7. Responsible for oversight and/or development of multiple simultaneous projects.

8. Report on all aspects of project materials and how they relate to current business/OD&T objectives.

9. Partner with associates and leadership to ensure training and development supports key business objectives.

10. Coordinate with other Instructional Designers, Trainers, and Manager of Instructional Design to ensure accurate and timely delivery of courses.

11. Participate in the evaluation of courses to identify opportunities and suggest strategies for improvement.

12. Produces work of consistently high quality and shows initiative to innovate and excel in established processes.

13. Research current methodologies and technologies and make recommendations as to their use.

14. May lead Instructional Designers and consultants as it pertains to specific projects.

15. Complete other special projects and duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree or equivalent experience.

Preferred:
- Master’s degree in English or Instructional Design.

Years and Type of Experience Required:

Required:
- 3 experience creating training materials for instructor-led and/or computer-based training.
- 3 years experience working in a corporate training environment.

Preferred:
- CareCompass, MACESS, and Facets
- Instructional designer, trainer, or managed care certification a plus.
- Experience in corporate training or education.

Specific Technical Skills

Required:
- Proficient to expert skill in Microsoft Office applications.

Preferred:
- Adobe Connect, Photoshop, and Captivate experience.

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:
- Document design and layout experience.

SCOPE INFORMATION

Item Measure
- # Direct Reports 0
- # Indirect Reports 5-10
- Budgetary $ Responsibility 0

PHYSICAL REQUIREMENTS
- Must be able to operate a computer, telephone and other commonly used business-related items.
- Must be able to travel (10-20%) on common carriers and adhere to AGP’s travel policy.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Instructional-Designer-II-Job-VA-23450/2585344/258534425853442013-07-18AmerigroupHuman Resourcesfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22790 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/7/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for assisting with the management and oversight of IT Enterprise Architecture (EA) program. Acting independently as recognized EA expert, position is responsible for the overall Information Systems architecture discipline including assisting with the planning, design, and integration of IT technology across the enterprise. Responsible for assisting with technology planning and emerging technology evaluations in the context of the architecture discipline. As an expert in the field, uses industry standard frameworks and concepts in developing solutions to complex information technology problems. Works on issues that impact design/implementation success or address future concepts, products or technologies. Aligns new technology with business needs and processes to ensure that IT can adapt to changing business needs while meeting negotiated service level agreements. 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.

The Healthcare Solution Architect supports the company’s Healthcare IT system solutions. This position is responsible for developing and documenting discovery process, solution architecture , project , and consistent repeatable solution artifacts . The position also supports technology planning and emerging technology evaluations in the context of healthcare solution development within the EA architecture discipline. As an expert in Healthcare IT, the solution architect borrows from industry standard frameworks and concepts, such as Agile, SCRUM, ArchiMate, Rational Unified Process, and UML, to develop consistent, repeatable use solutions to complex information technology problems. The Solution Architect works on issues that impact design/implementation success or address future concepts, products or technologies. The Solution Architect aligns new technology with business needs and processes to ensure that IT can adapt to changing business needs while meeting negotiated service level agreements. 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.

Responsibilities:

1. Responsible for administration of the IT Enterprise Architecture program to include adaptation and integration of industry standard architecture frameworks. Ensures alignment and compliance with architecture methodologies, requirements, and guidelines.

2. Functions as an expert-level technical advisor with advanced knowledge and experience in the area of information systems architecture and design.

3. Responsible for translating business requirements into specific systems, applications or process designs for complex IT solutions.

4. Acts as an advocate for internal and external business partners, as the ultimate authority on the architecture designed to address business related problems.

5. Takes responsibility for technical planning, architecture development and modification of specifications. Develops specifications for new products/services, applications and service offerings. Assesses the compatibility and integration of products/services proposed as standards in order to ensure an integrated architecture across interdependent technologies.

6. Assists with the strategic planning to ensure IT architecture meets current and future requirements and develops the methodologies for system design, analysis, and support.

7. Proactively identifies and solves the most complex problems with relation to architecture planning, analysis, and design.

8. Often involved in modifying or adapting existing designs.

9. Develops technical standards, and assists in the planning and design of all corporate information technology solutions.

10. Performs analysis of vendor products to determine best fit for company needs and assists in the presentation of information to management for purchase decisions.

11. Provides leadership and technical direction for all ITS departments as a function of the overall implications of the enterprise architecture.

12. Perform other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree. Equivalent experience is acceptable in lieu of a degree(s).

Preferred:
- Master’s Degree

Years and Type of Experience Required:

Required:
- A minimum of 8 years of relevant work experience.

Certifications or Licensures

Required:
- The Open Group Architecture Framework (TOGAF) Certification. FEAF or DoDAF accepted in lieu of TOGAF.

Preferred:
- MCP, CCNP or CCA - MCSE , CCNP,CCEA, CISSP
- Note that some certifications and/or licensures may be required depending on the specific area of focus for the incumbent position.

Language Skills

Required:
- English

Technical Competencies

Computer hardware, software, applications - Expert
- Able to apply multi-disciplinary infrastructure and enterprise architecture technical solutions across multiple platforms to address complex business needs.
- Broad responsibility/scope of influence over design, build and deployment of complex hardware and software. - Deep understanding of desktop, network and server-based Operating Systems (OS). Deep and broad understanding of how applications function (e.g. MicroSoft, Citrix, Cisco, Avaya, etc.) and how they're administered, and specializes in more than one application.
- Able to integrate environments across multiple platforms.
- Deep and broad understanding of how enterprise systems are administered and maintained. Deep understanding of IP networking, Voice and Video services and Telecom fundamentals.
- Solid understanding of other technologies, theory, functionality, etc.

Infrastructure Performance Analysis - Expert
- Advanced understanding of best practices in managing an Enterprise Architecture program.
- Maintains situational awareness of systems and applications.
- Able to implement effective course corrections based on deep knowledge of best practices and understanding of implications.

Able to proactively prescribe improvements and develop innovative hardware, software and application solutions in order to mitigate risk. IT Security - Advanced - Understanding of enterprise security and compliance best practices.

Technical Documentation - Expert
- Able to establish technical vision and conduct strategic planning.
- Able to monitor, guide and adjust strategic plan.
- Able to lead architecture process and create architectural artifacts. Able to document multi-year roadmap of technical solutions including budget and buy/build analysis and recommendations.
- Able to evaluate new and alternative solutions/technologies. Able to effectively develop and deliver presentations to groups.

Project Management - Expert
- Able to efficiently and effectively run multiple complex projects and manage deadlines with minimal direction or supervision. Behavioral Competencies: Strategic Leadership Be Strategic - Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 8

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.
- Periodic travel may be required

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Enterprise-Arch-Princ-I-Job-VA-23450/2585346/258534625853462013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22615 # Positions 1
Location US-LA-Metairie
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 6/6/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for daily management and coaching of Provider Services Team. Manages the functions relating to provider servicing, provider education and network development as appropriate in each Plan. Represents the Provider Relations Department at management meetings and interacts with management and staff of other departments as necessary.

Responsibilities:

1. Manages the Provider Services Team, including Provider Relations Representatives and Research Specialist(s) and other Provider associates as assigned in the Plan.

2. Monitors team activities to assure that staff meets performance standards and is operating effectively and efficiently.

3. Produces weekly/monthly/quarterly reports via Sales force CRM (or appropriate software per Plan) and reports on departmental metrics.

4. Responsible for handling escalated claims/operational issues and taking action to assure timely resolution of provider issues.

5. Evaluates the provider network to ensure appropriate access for membership and develops/executes recruitment plans.

6. Monitors staff workloads and makes recommendations on distribution of work.

7. Provides coaching and training to direct reports.

8. Recommends and/or drafts provider communications relative to health plan policies and procedures.

9. Oversees provider education activities including development of presentations for orientations and education.

10. Promotes positive relationships with the provider community and other AMERIGROUP departments.

11. Supports earnings improvement initiatives.

12. Manages the site visit process as part of provider credentialing.

13. Oversees provider marketing activities.

14. Interfaces with all other departments to ensure appropriate configuration of contracts, reimbursement rates, and benefits, and to address claims and operational issues.

15. Participates in standing meetings as necessary.

16. Ensures that inventory of provider communication materials is maintained.

17. Manages the provider complaint and Provider Relations databases.

18. Monitors provider complaints and makes recommendations to Directors and Vice President for addressing provider issues.

19. Develops and implements action plans regarding provider satisfaction results.

20. Leads provider profiling activities.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- BA/BS degree (or equivalent experience).

Years and Type of Experience Required:

Required:
- 5 Years of managed care experience and at least one year of leadership/management experience OR;
- Successful completion of Amerigroup Leadership Development Program in lieu of above years of experience.

Specific Technical Skills

Required:
- Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
- Knowledge of provider reimbursement methodologies, claims processing, billing practices, and fee schedules.
- Strong telephonic and customer service skills.
- Effective presentation skills.

Certifications or Licensures

Required:
- Must possess a valid driver’s license.

Other:

Required:
- Knowledge of healthcare terminology.
- Prior experience successfully managing people and projects.
- Ability to gain team support and motivate team to action.
- Excellent oral and written communication skills.
- Excellent problem solving skills.
- Ability to handle multiple tasks in a fast-paced environment.
- Appreciation of cultural diversity and sensitivity toward target population.

SCOPE INFORMATION

# Direct Reports: 1-8

# 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 locally.
- Must be able to operate a motor vehicle.
- Must be able to conduct and participate in meetings.

ermHO
]]>http://www.amerigroup-jobs.com/job/Metairie-Manager-Provider-Relations-Job-LA-70001/2551828/255182825518282013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSMetairie, LA, US
Job ID 2013-22681 # Positions 1
Location US-LA-Metairie
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 4/25/2013
Additional Locations ..

More information about this job:
Summary:

Performs general research and analysis to support business operations. Determines best practices and suggests how to improve current practices. Develops recommendations to solve problems and issues related to business operations. Prepare presentations to report findings to a functional or project leadership. Gathers business requirements, performs first level analysis, supporting the development and testing processes of assigned functional areas. Analyzes and reports on moderately complex business problems to be solved with automated systems or other resources.

Responsibilities:

1. Perform requirements gathering, analysis, and process and data flow diagramming for simple processes of moderate complexity.

2. Make recommendations for the Resolution of moderately complex design and functional area organizational issues utilizing department resources, business development lifecycle and development methods and software applications.

3. Read and interpret conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, and logical flow charts.

4. 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 development and/or product vendors.

5. Read and interpret a design document.

6. Develop and run moderately complex queries and reports for business analysis and trends.

7. Assist in the development of functional test plans used to verify specific system functions according to actual requirements and established guidelines.

8. Function as a liaison for IT and the business and other cross functional resources and departments.

9. Manage multiple priorities.

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience in a Business Analyst role is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Three years experience in business analysis or functional analysis role.

Preferred:
- Health care industry experience.

Certifications or Licensures

Preferred:
- CCBA certification (Certification of Competency in Business Analysis)

Language Skills

Required:
- English

Depending on the business area for a specific position, competency in one or more of the following may be Required:

Technical Competencies
- Demonstrate a basic understanding of core applications and systems.
- Demonstrate proficiency with all applicable company supported software applications.
- Able to provide professional and appropriate written information to internal and external customers.
- Able to initiate conceptual ideas with practical applications.
- Basic knowledge of the inter-relationship among various managed care operational areas.
- Basic knowledge of current technology trends.
- Able to develop and maintain customer relationships.
- Able to identify, analyze, and solve problems and to work with teams to solve problems.
- Able to develop and implement basic project plans.

Computer Skills and Office Equipment - Intermediate
- Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data. Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.

Spreadsheet Utilization and Management - Intermediate
- Proficient in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools.

Database Utilization and Database Management - Novice

Systems - Intermediate

Understanding of system's utilization and proficient retrieval of information and processing of the following systems:
- NetworX/Facets – build pricing based on provider contracts using Facets applications. Build benefit plans based on State regulations using Facets benefit applications.
- MACESS – contracts and claim images are stored. MACESS Workflow tool for contract life-cycle.
- Software products from Ingenix for prospective payment system (PPS) – pricing.
- Clearquest is used to track projects –knowledge and familiarity using a project inventory tracking system.

Applications/Tools - Intermediate

Ability to leverage available tools such as:
- TOAD, UltraEdit, Microsoft Project, Microsoft query analyzer SQL mgr, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity - Basic
- General healthcare, who are our providers (hospitals phy ofc, ancil) who are payors (insurance companies),
- High level claims process, knowledge of general industry how it works.
- More specific knowledge around reimbursement methodology, fee schedules. Per case, per diem, DRG, % of charges, those terms. HIPAA.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping DRG codes, place of service codes (POS),

Government Programs Specific Knowledge
- Medicare Medicaid programs, CHIP and LTC.
- Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Gather and Document Requirements - Intermediate
- Ability to prepare simple to moderately-complex requirements documents. Ability to facilitate requirements gathering including determining the most efficient and effective way to capture the requirements, and managing kick off and subsequent status meetings. Ability to manage timelines and due dates. Ability to recognize and understand business changes that impact requirements and incorporate changes into documentation. Ability to read and re-read requirements documents multiple times while maintaining detail orientation.

Contracts - Intermediate
- Ability to read a contract and understand the operational requirements the contract creates. Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving-Analytics - Basic
- Critical thinking and problem solving methods.

Project Management - Intermediate
- Skilled in running a project utilizing standard project management tools, techniques and methodology. Keeps projects on task.

Testing - Intermediate
- Functions independently in the creation of simple to moderately-complex test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Metairie-Operations-Business-Anlyst-II-Job-LA-70001/2566935/256693525669352013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSMetairie, LA, US
Job ID 2013-22864 # Positions 1
Location US-LA-Metairie
Search Category Finance
Type Regular Full-Time (30+ hours) Posted Date 5/15/2013
Additional Locations ..

More information about this job:
Summary:

To develop, maintain and enhance mechanisms to track, report, and provide feedback related to company financial performance. To support the data analysis needs of Finance at the Health Plan.

Responsibilities:

1. Produces, analyzes and maintains reports used to measure, monitor and manage quality of care and service as well as other financial analysis.

2. Utilizes knowledge of databases, information systems, statistical tools and analytical principles to analyze outcomes that support strategies for managing health plan performance.

3. Compiles and analyzes data including quality indicators, performance scorecard and quality improvement activities.

4. Performs statistical tests to determine statistical significance, confidence level, validity and reliability of outcome.

5. Supports systems to provide trended data related to State required clinical outcomes measures.

6. Assists in the development of databases and analysis tools to measure clinical outcomes and prevention initiatives.

7. Develops, standardizes, maintains and enhances reports for State quality reporting.

8. Participates in clinical focus study development, data collecting and analysis.

9. Trends quarterly data and develops aggregate and individual data reports.

10. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelors degree in business, science, healthcare or related field.

Years and Type of Experience Required:

Required:
- Minimum 3 years data or finance analysis or statistical experience.

Preferred:
- Previous HMO/Managed Care industry experience preferred.

Specific Technical Skills

Required:
- Proficient with window based environment software tools.
- Stung Microsoft Excel and Access skills.
- Working knowledge of information systems including database design.

Preferred:
- Knowledge of SPSS.
- Understanding of ICD-9 and CPT coding system and claims helpful.

Other:

Required:
- Excellent analytical skills.
- Attention to detail.
- Excellent organizational skills; the ability to handle multiple priorities simultaneously with a high quality result.
- Appreciation of cultural diversity towards target population.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.
- Must be able to operate a calculator.

ermCorp
]]>http://www.amerigroup-jobs.com/job/Metairie-Finance-Analyst-Plan-Job-LA-70001/2599783/259978325997832013-07-18AmerigroupFinancefull-timeUSDstarting0BSMetairie, LA, US
Job ID 2013-22791 # Positions 1
Location US-VA-Virginia Beach
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 5/7/2013
Additional Locations ..

More information about this 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.
- Technical knowledge of infrastructure to understand risks and impacts
- Knowledge of ITIL Change, Configuration, and Release Management, process, policies, and procedures
- Technical analysis and problem solving skills
- Understanding of testing processes, QA and Prod
- Good understanding of data and audit items required in each change record
- Analyzing a change record to ensure they are appropriately categorized and populated and the capability to reach out to the teams if they need more information
- Facilitates Change Advisory Board (CAB) meetings and prepares and distributes the agenda
- Monitors changes to endure compliance with the CM Policy and process and marks out of compliance changes as a violation
- Helps with CM Process improvement
- Auditing of Changes running reports on status

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. Performs other duties as assigned or requested.

Qualifications:

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:
- Eight years related work experience.

Language Skills

Required:
- English

Technical Competencies:

Computer Hardware, Software and Applications / Office Equipment – Expert
- Comprehensive understanding of the inter-relationship among various IT applications and systems. Complete proficiency with all applicable company supported software applications. Moderate to comprehensive understanding of supported applications and all interdependencies (OS, network, server, workstations, etc.).
- Ability to use hardware and software of a computer to complete certain complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
- Proficiency in a windows environment to include navigation skills and use of internet. Ability to review and draft correspondence in email and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Applications System Analysis - Expert
- Comprehensive understanding of object oriented development language, object states and methods, and encapsulation. Solid understanding of variables, data types, expressions, control flow statements, arrays and strings. 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. Understands infrastructure associated with supported applications.

Project Management - Advanced
- Ability to develop and implement moderately complex project plans. Able to develop and implement budget plans.

Behavioral Competencies:

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermIT
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-ITS-Applicatn-Analyst-Princ-I-Job-VA-23450/2585347/258534725853472013-07-18AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22816 # Positions 1
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/10/2013
Additional Locations ..

More information about this job:
Summary:

Provides leadership, strategic planning and direction for vendor contracts within Cost Containment and related services. These functions include, but are not limited to research, contracting, implementations, recovery processes, and outcome reporting to department and senior operations management. Fosters collaborative relationships with each health plan and internal departments to ensure cost containment activity and recovery efforts are completed within all company, state and federal requirements.

This position will sit in our Virginia Beach office.

Responsibilities:

1. Researches and identifies appropriate vendor solutions for cost containment initiatives.

2. Directs all vendor functions related to the identification and recovery of overpayments.

3. Negotiates contract terms and conditions with vendors primarily for but not limited to cost containment.

4. Ensures compliance with Amerigroup policies and procedures including Legal and Regulatory compliance and signoff. Ensures that the most effective financial terms are achieved, and that all state compliance-related issues are met.

5. Executes all vendor contracts from initial analysis and budgeting through implementation.

6. Monitors contract performance relevant to delivery schedules, applicable laws, payment provisions, performance metrics, and other pertinent requirements.

7. Responsible for the on-going evaluation and management of reimbursement recovery opportunities related to vendor projects through direct management and direction of staff.

8. Directs the research and resolution of escalated provider complaints, identifying trend patterns and creating corrective action plans to address root cause issues related to vendor projects.

9. Validates all vendor invoices in compliance with contract terms and recovery accuracy, ensuring recoupment is completed prior to payment.

10. Directs staff in the collection of provider negative balances, and interface with the provider, health plan provider relations staff, claims, legal, finance and other departments as needed.

11. Coordinates formal responses to vendor recovery questions/issues by health plans, states, etc. including matters of subrogation and coordination of benefits.

12. Achieves departmental/corporate goals through the ongoing selection, performance management and development of employees, including personal development and leadership skills.

13. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in related field or equivalent experience.

Years and Type of Experience Required:

Required:
- Eight years of experience with health insurance claims and/or recovery, with a minimum of three years in a managed care organization.
- Five years of leadership and/or management experience.

Language Skills

Required:
- English

Technical Competencies

Computer Skills and Office Equipment
- Ability to use software and hardware of a computer to complete certain moderately-complex to complex tasks.
- Able to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard, 10 key and typing at 35 words/minute.
- Use of internet and some familiarity with SharePoint sites.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to problem solve.
- Ability to create and manipulate spreadsheets (i.e., data entry and format cells).
- Ability to work in databases.

Read, Interpret and Apply Information
- Ability to research information using available resources.
- Read and comprehend the information to analyze and apply logical thinking in making sound decisions.
- Understand and apply general instructions to appropriately and accurately process claims.
- Capacity to follow step-by-step and general directions, remain detail oriented and verify data from EOB's including HIPAA documentation.
- Ability to investigate and review claim from initial receipt.
- Ability to apply in-depth problem solving with more complex claims.
- Ability to read and interpret contract terms as related to payment policies for outpatient and inpatient claims.

Medical, Recovery & Billing Terminology
- Understanding of medical terminology used in claims documentation.
- Knowledge of other healthcare companies and third party insurance.
- Understanding of Cost Containment/Overpayment processes, such as COB.
- Familiarity with claims medical coding.
- Working knowledge of recovery practices.
- Understand DRG, capitation - per diem rules.
- Understand the different levels of care and applicable payment methodology.

System Familiarity
- Ability to use a claims adjudication system to process claims, such as Facets.
- Familiarity with an image repository-review system for the retrieval of documents.
- Ability to identify system issues to management for problem solving.
- Understanding of the system configuration concepts for benefits, pricing, and provider set up.

Communication Skills

Verbal, Written and Telephonic
- Ability to convey complex messages to a variety of audiences in an effective manner using proper language, grammar and style in the preparation of verbal and written messages.
- Skills to properly handle telephone inquiry with customers (providers, vendors and other health insurance carriers).
- Ability to prepare, edit and convey a variety of messages including presentations, settlement materials and updates.
- Ability to handle escalated issues through verbal and written messages.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Integrates and balances big-picture concerns with day-to-day activities.
- Conveys a thorough understanding of own area's strengths, weaknesses, opportunities, and threats.
- Evaluates and pursues initiatives, investments, and opportunities based on their fit with broader strategies.
- Stays abreast of key competitor actions and their implications or threats to the business.

Make Sound Decisions
- Focuses on important information without getting bogged down in unnecessary detail.
- Probes and looks past symptoms to determine the underlying causes of problems and issues.
- Brings to bear the appropriate knowledge, information, and expertise in making decisions.

People Leadership Develop / Support Organizational Talent
- Identifies the qualifications required for successful job performance.
- Provides honest, helpful feedback to others on their performance.
- Helps others identify and prioritize their development objectives.
- Promotes sharing of expertise and a free flow of learning across the organization.

Ensure Collaboration
- Discourages "we vs. they" thinking.
- Appropriately involves others in decisions and plans that affect them.
- Works to remove barriers to collaboration.
- Seeks to understand and address the concerns and interests of others with opposing viewpoints.

Results Leadership Show Drive and Initiative
- Does not easily give up in the face of unexpected obstacles.
- Sets high standards of performance for self and others.
- Puts in extra effort and work to accomplish critical or difficult tasks.
- Tackles tough challenges or problems quickly and directly.

Accountability/Optimize Execution
- Conveys clear expectations for assignments.
- Delegates assignments to the lowest appropriate level.
- Monitors progress of others and redirects efforts when goals change or are not met.
- Holds people accountable for achieving their goals.

SCOPE INFORMATION

# Direct Reports: 4

# Indirect Reports: 50-60

Budgetary $ Responsibility: $4-10 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.

ermCS
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Director-Cost-Containment-Job-VA-23450/2592118/259211825921182013-07-18AmerigroupCustomer Servicefull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22820 # Positions 1
Location US-VA-Virginia Beach
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/10/2013
Additional Locations ..

More information about this job:
Summary:

Provides leadership and direction for all production-related cost containment activities across all markets to include overpayment recovery, coordination of benefits, third party liability recovery, fraud and abuse and medical claims review. Accountable for team performance measures. Manages cost containment vendor relationships. Serves as a primary contact for legal and regulatory issues regarding claims or cost containment. Possesses the business and technical expertise required to perform the critical tasks of the job.

Responsibilities:

1. Ensure recovery PMPM and overall dollar targets are met.

2. Coordinate efforts with health plans to maximize recovery efforts, yet minimize impact to provider networks.

3. Establish/maintain/improve processes to identify and recover overpaid/misplaced funds while ensuring adherence to state mandated requirements.

4. Coordinate closely with Legal and Provider Configuration to “flag” suspect providers, conduct investigations and close cases in a timely manner.

5. Coordinate with Claims teams to help identify potential recovery opportunities and to communicate any root causes of errors found in the overpayment review process.

6. Implement quality assurance program across all functions within Cost Containment.

7. Coordinate with Quality Assurance and cost containment vendors to track processing errors seen in overpayment recovery. Provide feedback to appropriate department such as Claims, Enrollment and Provider Configuration.

8. Partner with Medical Finance to ensure reported savings are accurate and validated.

9. Ensure that information provided to Cost Containment team members is consistent with information other departments, i.e., Special Processing Instructions (SPIs) from Claims, Medical Management information, etc.

10. Responsible for writing and updating policies and procedures related to cost containment activities.

11. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in related field or equivalent experience.

Years and Type of Experience Required:

Required:
- Five years of experience in operations in a managed care or financial organization with at least one year of leadership/supervisory experience.

Preferred:
- Cost containment or claims processing experience.

Language Skills

Required:
- English

Technical Competencies Computer Skills and Office Equipment
- Ability to use software and hardware of a computer to complete certain moderately-complex to complex tasks.
- Able to use basic office equipment such as telephone, fax machine and copy machine.
- Working knowledge in a windows environment to include navigation skills using a mouse, keyboard, 10 key and typing at 35 words/minute.
- Use of internet and some familiarity with SharePoint sites.
- Ability to review and draft correspondence in email system and word processing systems.
- Ability to use software for data analysis, reporting and sharing of information to problem solve.
- Ability to create and manipulate spreadsheets (i.e., data entry and format cells). - Ability to work in databases.

Read, Interpret and Apply Information
- Ability to research information using available resources.
- Read and comprehend the information to analyze and apply logical thinking in making sound decisions.
- Understand and apply general instructions to appropriately and accurately process claims.
- Capacity to follow step-by-step and general directions, remain detail oriented and verify data from EOB's including HIPAA documentation.
- Ability to investigate and review claim from initial receipt.
- Ability to apply in-depth problem solving with more complex claims.
- Ability to read and interpret contract terms as related to payment policies for outpatient and inpatient claims.

Medical, Recovery & Billing Terminology
- Understanding of medical terminology used in claims documentation.
- Knowledge of other healthcare companies and third party insurance.
- Understanding of Cost Containment/Overpayment processes, such as COB.
- Familiarity with claims medical coding.
- Working knowledge of recovery practices.
- Understand DRG, capitation - per diem rules.
- Understand the different levels of care and applicable payment methodology.

System Familiarity
- Ability to use a claims adjudication system to process claims, such as Facets.
- Familiarity with an image repository-review system for the retrieval of documents.
- Ability to identify system issues to management for problem solving.
- Understanding of the system configuration concepts for benefits, pricing, and provider set up.

Communication Skills: Verbal, Written and Telephonic
- Ability to convey complex messages to a variety of audiences in an effective manner using proper language, grammar and style in the preparation of verbal and written messages.
- Skills to properly handle telephone inquiry with customers (providers, vendors and other health insurance carriers).
- Ability to prepare, edit and convey a variety of messages including presentations, settlement materials and updates.
- Ability to handle escalated issues through verbal and written messages.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Sees the "big picture" (e.g., overall themes, trends, goals).
- Integrates and balances big-picture concerns with day-to-day activities.
- Establishes strategies for achieving individual or work unit goals.

Make Sound Decisions
- Analyzes, incorporates and applies new information and concepts.
- Recognizes symptoms that indicate problems.
- Makes sound decisions on everyday issues and problems.
- Makes timely decisions on problems/issues requiring immediate attention.

People Leadership Develop/Support Organizational Talent
- Identifies and recruits/refers qualified people.
- Makes accurate evaluations of people's capabilities and fit.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Ensure Collaboration
- Provides sound rationale for recommendations.
- Solicits support for ideas.
- Ensures that own positions address others' needs and priorities.
- Builds relationships to create a foundation for future influence.

Results Leadership Show Drive and Initiative
- Identifies what needs to be done and does it.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Conveys clear expectations for assignments.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Seeks additional resources to complete tasks when needed.

SCOPE INFORMATION

# Direct Reports: 3-6

# Indirect Reports: 10-25

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.

ermCS
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Mgr-Cost-Containment-Job-VA-23450/2592121/259212125921212013-07-18AmerigroupCustomer Servicefull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22819 # Positions 1
Location US-VA-Virginia Beach
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/10/2013
Additional Locations ..

More information about this job:
Summary:

Works independently and with considerable latitude to build collaborative working relationships with the leads of multiple corporate areas, the leadership at individual health plans, and with state employees as appropriate. Leverages these relationships combined with working understanding of the various corporate departments to evaluate cross-functional processes and coordinate activities on behalf of the health plans. Typically supports health plans that are large in size and/or have moderate complexity in terms of products, contracts, issues, etc. and/or multiple plans. Identifies issues and/or opportunities and develop action plans to address identified priorities. Demonstrates a high level of flexibility, managing multiple projects across health plans based on strategic priorities, ensuring that any potential issues and risks are communicated timely. Ensures accountability from all applicable entities – both at Corporate and the Health Plan.

This is a sourcing requistion. We will be looking to fill this role in the 3rd quarter of 2013.

Responsibilities:

1. Aligns corporate departments to systematically implement needed changes to support the strategic initiatives of each health plan.

2. Analyzes business processes or issues and recommends possible solutions and methods of executing plans.

3. Proactively identifies opportunities for process improvements in operations performed at Corporate or the health plan.

4. Provide support to Health Plan during operational audits – both internal and external.

5. Functions as an operational contact to the state as requested by the Health Plan, engaging team members as appropriate.

6. Coordinates and facilitates cross-functional issue resolution sessions emphasizing issue identification, root cause analysis, and eradication.

7. Escalates issues to senior leadership as appropriate when issues develop pertaining to state contract compliance. Follows up with the appropriate individuals for prompt resolution.

8. Reviews the performance of corporate departments against service level agreements and regulatory mandated performance guarantees.

9. Organizes communication between assigned health plans and the corporate departments to identify opportunities, ensure resolution and execution of solutions, and provide updates on strategic initiatives and plans.

10. Ensures action plans completed by the various corporate departments are enacted timely and communicated to the impacted Health Plan.

11. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in Business Administration, Management Information Systems, Health Care or a related discipline. Equivalent experience is acceptable in lieu of a degree(s).

Preferred:
- Master’s degree preferred.

Years and Type of Experience Required:

Required:
- Five years relevant work experience, e.g. account management experience outside the healthcare industry or operational healthcare experience, and at least one year of leadership/management experience.
- Project Management, Account Management, or leadership experience in a medium to large size business environment.

Preferred:
- Experience in managed healthcare industry.

Certifications or Licensures

Required:
- N/A

Preferred:
- PMP
- Six Sigma or equivalent certification.

Language Skills

Required:
- English

Functional Competencies

Industry Knowledge and Terminology – have a solid understanding of the managed healthcare industry and the underlying supporting processes and systems, including who are providers, who are payors and how the industry works; knowledge around reimbursement methodology, fee schedules and related terminology, e.g. per case, per diem, DRG, % of charges, etc.

Cause and Effect Determination – ability to work with and get input from other areas to determine the source and root cause of errors, e.g. claims or reporting errors.

Governance Programs – have a solid understanding of Medicare/Medicaid programs, including eligible populations, general covered services, etc.

Contracts – ability to interpret and understand the language and terminology used in moderate to complex federal, state and provider contracts, i.e. contract covers multiple products, to determine operational requirements.

Software and Systems – ability to interact with and manipulate software applications and tools utilized to support healthcare operations; knowledge of claims payment system architecture and configuration.

Research – ability to utilize multiple resources, both internal and external, to identify and validate documentation and information used to resolve issues.

Industry Codes – have a solid understanding of code sets such as revenue codes, procedure codes, Diagnoses Related Grouping (DRG) codes, place of service codes, etc.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 0

Budgetary $ Responsibility: 0-$1m

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Account-Manager-III-Job-VA-23450/2592122/259212225921222013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22843 # Positions 1
Location US-VA-Virginia Beach
Search Category Communications
Type Regular Full-Time (30+ hours) Posted Date 5/14/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for ensuring the overall quality of designated Proposal Management projects with elements such as researching, writing and organizing documents in support of Amerigroup’s business development and proposal efforts. Responsible for on-boarding, training and managing associate and consultant writers, editors and compliance reviewers and copy editors. In this role, tactical execution is necessary to prepare well-written responses/documents that comply with Requests For Proposal (RFPs) and Requests for Information (RFIs) from start to finish, working with subject matter experts (SMEs) to gather information and provide high-quality proposal responses. Serve as a leader within the department (to other writers and production team members) and outside the department to executives, associates and external consultants and vendors.

Responsibilities:

1. Responsible for developing, creating, reviewing, editing and managing designated RFPs. Develop training materials to efficiently educate writers on the Amerigroup process.

2. Create or refine proposals, an ability to cite proposal portions that require clarification and supporting proof/data points, verifying and amending content/data gaps, confirming strategy/product alignment.

3. Supervise the processes and procedures of designated RFPs. Schedule deliverables and ensure that consultants are available in the needed timeframes.

4. Responsible for the on-boarding of new consultant writers and editors to include pre-screen interviews, assessing strengths and areas of writing expertise and asissitng new consultants through the onboarding process.

5. Coordinate and schedule (including working with appropriate presenters) training sessions as needed for new associate and/or consultant training so that writers/editors/reviewers have an understanding of the Amerigroup proposal process.

6. Perform relevant segments of aforementioned training (Corporate background and experience, process, roles and responsibilities, etc).

7. Provide Leadership to the department and participate in constructive assistance to other writers including consultants; Assist with the on-going. management/administration of proposal writers and editors (associates and consultants) in the Amerigroup database.

8. Conduct research to obtain information for proposal content development. Prepare presentation documents with content and direction provided by others.

9. Lead kick-off, strategy, and debrief meetings respective to writing assignments.

10. Develop responses to complex RFP/RFI requirements by working with identified SMEs to determine and develop responses for specific content for assigned sections.

11. Write assigned sections ensuring compliance with the RFP/RFI requirements. Proofread proposals to apply company standards for accuracy, quality writing, and marketing focus. Revise sections as directed.

12. Conceptualize supporting graphics for documents to illustrate and simplify concepts; work with assigned graphic designers to produce final versions of illustrations for insertion into the document.

13. Lead the online market analysis and proposal content database maintenance process.

14. Perform other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in English, Marketing, Journalism, Communications or Health Systems Administration with twice the required management and writing experience listed below.

Preferred:
- Master’s degree in English, Marketing, Journalism, Communications or Health Systems Administration.

Years and Type of Experience Required:

Required:
- Minimum of five (5) years experience with proposal-development writing and project management on large and complex RFP responses.
- Minimum of three (3) years managing and training internal or consultant team members, specifically in the areas of writing, editing, RFP review, or project management.
- Demonstrated success in proposal writing.
- Excellent skills in writing clear and focused copy that meets strategy and objectives.
- Demonstrated success in managing projects from conception to execution.

Preferred:
- Minimum of seven (7) years experience with proposal-development writing and project management on large and complex RFP responses.
- Technical writing or proposal development in the health-insurance field.
- Working knowledge of Medicaid or other public-sector healthcare program.
- Excellent project management and planning skills.
- Working knowledge of publication production tools.
- Experience as a proposal evaluator.

Certifications or Licensures

Required:
- N/A

Preferred:
- Association of Proposal Management Professionals (APMP) Foundation, Practitioner, or Professional Accreditation.

Functional Competencies
- Ability to use software and hardware of a computer to complete certain moderate to complex tasks.
- Working knowledge in a windows environment, in particular with Word, PowerPoint, and Excel, to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize, and edit data.
- Preferred working knowledge of publication production tools.
- Ability to use software to conduct data analysis, reporting, and sharing of information to solve problems. Ability to use of complex applications of software to analyze and solve business problems.
- Ability to read, comprehend and interpret complex information to provide accurate and appropriate information to business partner or customer.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.
- Ability to understand when to escalate erroneous/inconsistent information discovered in resources to appropriate level of management for review.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 10-15

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 as needed and adhere to Amerigroup travel policies and procedures.


]]>http://www.amerigroup-jobs.com/job/Virginia-Beach-Manager-Proposal-Writing-&-Editing-Job-VA-23450/2597180/259718025971802013-07-18AmerigroupCommunicationsfull-timeUSDstarting0BSVirginia Beach, VA, US
Job ID 2013-22901 # Positions 1
Location US-TX-Houston
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 5/17/2013
Additional Locations ..

More information about this job:
Summary:

Under direct supervision, responsible for supporting the project managers, business analysts, or functional area leadership by coordinating project administration, reviewing, revising and maintaining critical documents required to support assigned projects. Support the functional aspects of the assigned team or department, including overall project and team administration, tracking of internal resources and expenses, process support and training, project budget management, report analysis, and project plan development and reviews.

Responsibilities:

1. Maintain required documentation including SharePoint sites, organization charts, distribution lists, meeting minutes, project logs, project schedules, requirements documents, project budgets, and status reports.

2. Provide logistics related to project management support including scheduling meetings, negotiating meeting space, room set up, meeting materials preparation and distribution, and catering as well as arranging for and testing all meeting technology such as polycom phones, WebEx, video teleconferencing, microphones or projection.

3. Works from list of tasks provided by functional area experts, existing documents and project plans, notes, and general communications to prepare and maintain an overall project plan using the selected project management tools.

4. Works with functional area experts and the project manager to develop concise, complete, accurate, and clear specifications of project deliverables for the overall project and subprojects.

5. Reviews, edits, and revises appropriate documents produced by others in support of projects.

6. Researches and develops small programs or SOPs for review and edits.

7. Assists the project manager and other team members in developing and documenting temporary operational workflows and procedures used in transitioning the business organization through implementation and ultimately go-live.

8. Reproduces, binds, and distributes project documents.

9. Assist in developing and setting publications standards for the project documentation products.

10. Acts as liaison between project team and assigned functional area for project-related communications and tasks; coordinates status reporting, monitor’s deliverable execution, etc.

11. Assist in conducting training on process, tools, and best practices for associates.

12. Participates and coordinates various workgroups related to process improvement in support of assigned projects.

13. Coordinates standard report development in support of assigned projects and the Project team.

14. Assists in maintaining relationships with external vendors in support of assigned projects and the Project team.

15. May perform additional administrative functions, to include but not limited to, travel, expense reports, delegating calendars, etc.

16. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Associate’s degree or equivalent combination of education and experience.

Preferred:
- Bachelor’s Degree

Years and Type of Experience Required:

Required:
- Two years Project Coordination or Executive Administrative Assistance experience.

Preferred:
- Health care insurance industry experience.
- MS Project, Outlook, PowerPoint and Visio experience.
- Survey tools experience, e.g. Survey Monkey.

Language Skills

Required:
- English

Technical Competencies

Project Management - Basic
- Ability to plan, coordinate. Organize and lead project administration and maintain critical project documents in accordance with industry standards and best practices as established by organizations such as Project Management Institute (PMI).

Industry Knowledge & Familiarity - Basic
- General knowledge of the healthcare industry and government insurance programs, e.g. Medicare, Medicaid, CHIP and LTC.

Computer Skills and Office Equipment - Basic
- Ability to use software and hardware of a computer (e.g. Outlook, PowerPoint, etc.) to complete certain simple tasks. Able to use basic office equipment such as telephone, video teleconference equipment, fax machine and copy machine. - Working knowledge in a windows environment to include navigation skills using a mouse, keyboard and 10 key. Use of internet, familiarity with SharePoint sites. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to open, review, edit and save data.

Behavioral Competencies

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others’ opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability / Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

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.

ermHO
]]>http://www.amerigroup-jobs.com/job/Houston-Project-Coordinator-I-Job-TX-77001/2604265/260426526042652013-07-18AmerigroupHealth Care Operationsfull-timeUSDstarting0BSHouston, TX, US
Job ID 2013-22886 # Positions 1
Location US-TX-Houston
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/17/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective care management, utilization of health, mental health, and substance abuse services. Successful candidates must currently resided in or be willing to relocate to the Houston area.

Responsibilities:

1. Manages and oversees teams responsible for various HCMS functions including utilization ma