http://www.amerigroup-jobs.com/feeds/amerigroup-dme-providers-jobs/ Custom RSS Feed for amerigroup-dme-providers-jobs Thu, 23 May 2013 19:40:11 GMT en-us /sites/amerigroup/images/banner.gif http://www.amerigroup-jobs.com/feeds/amerigroup-dme-providers-jobs/ 720
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
]]>Fri, 03 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Business-Consultant-RN%2C-Quality-Management-Job-VA/2304822/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Business-Consultant-RN%2C-Quality-Management-Job-VA/2304822/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22412 # Positions 1
Location US-TX-Austin
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 3/31/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for member retention by investigating and leading the resolution of member complaints. Serve as a liaison/mediator between member, the provider and Plan, Provide education to the member on Medicaid Managed Care and their benefits with AMERIGROUP, informing and ensuring that members are aware of their rights and responsibilities, the complaint process, and health education activities available in the community. Support member outreach activities.

Responsibilities:

1. Investigate, resolve, and document member complaints in accordance with AMERIGROUP policies and State requirements.

2. Conduct out-of office / home visits with members to educate and advise on AMERIGROUP programs, policy, and benefits as appropriate.

3. Investigate and resolve issues regarding members with non-compliant, behavioral, and abusive conduct identified by providers. Work with law enforcement officials as appropriate.

4. Conduct member interviews to ensure that members are informed of their rights and responsibilities.

5. Assist with member education related to prevention, outreach and education programs.

6. Identify members to participate on Plan committees.

7. Assist member as needed, including locating a PCP, obtaining medical records, obtaining transportation, and completing required forms. Resolution and coordination in barriers to care needs.

8. Assist in the preparation for a Grievance Panel, assuring member participation and explaining the process to the member.

9. Review complaint reports for accuracy and completeness and ensure required reports meet timely filing requirements.

10. Participate on the weekly complaint review committee as appropriate.

11. Assist in the maintenance of the complaint database.

12. Prepare additional reports and presentations as needed to support community relations, Provider Services and member education activities.

13. Attend community events as appropriate.

14. Track, trend, and report quality and access complaints by provider. Coordinate with provider relations for follow-up of issues identified.

15. Act as member advocate with providers, CBO’s, and AMERIGROUP associates as indicated.

16. Serve as liaison with state hot line staff and internal compliance personnel.

17. Work with other AMERIGROUP departments and with physicians to resolve member issues.

18. Establish and maintain working relationships with member advocacy groups.

19. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Two-year degree in a related field or; 3 – 5 years experience in a social or health related service-oriented industry.

Years and Type of Experience Required:

Required:
- 3 – 5 years experience in a social or health related service-oriented industry.
- Experience with complaint/grievance processes.

Preferred:
- Previous experience in a Medicaid Managed Care Health Plan.
- Successful record of community volunteer work.
- Previous experience in outreach to members to include resolution of issues.

Specific Technical Skills

Required:
- Excellent interpersonal, organizational, problem solving, multitasking, analytical and communication skills.
- Excellent Customer Service skills.
- Appreciation of cultural diversity and sensitivity towards target population.
- Professional telephone etiquette.
- Strong mediation skills.
- Ability to work calmly and effectively under adverse conditions.
- Computer keyboard and word processing proficiency.

LANGUAGE SKILLS

Prefered:
- Bi-lingual

Certifications or Licensure

Required:
- Must possess a valid driver’s license and required insurance.

Other:

Required:
- Ability to work evenings and weekends as needed.

Preferred:
- Established working relationships with Community Based Organizations.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.
- Local travel required - must be able to travel locally to physician offices and members homes.
- Must be able to communicate verbally.
- Must be able to tolerate standing and sitting for long periods of time.
- Must be able to operate a motor vehicle.

ermHO
]]>Mon, 29 Apr 2013 03:01:00 GMThttp://www.amerigroup-jobs.com/job/Austin-QM-Membr-Advocate-Job-TX-73301/2521543/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Austin-QM-Membr-Advocate-Job-TX-73301/2521543/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22338 # Positions 3
Location US-NY-New York
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 3/21/2013
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
]]>Sat, 18 May 2013 05:31:00 GMThttp://www.amerigroup-jobs.com/job/New-York-Provider-Relations-Rep-II-Job-NY/2494367/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/New-York-Provider-Relations-Rep-II-Job-NY/2494367/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
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
]]>Fri, 26 Apr 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Las-Vegas-Provider-Relations-Rep-II-Job-NV-89044/2569050/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Las-Vegas-Provider-Relations-Rep-II-Job-NV-89044/2569050/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22723 # Positions 1
Location US-LA-Shreveport
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/1/2013
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
]]>Wed, 01 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Shreveport-Provider-Relations-Rep-II-Job-LA-71101/2576448/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Shreveport-Provider-Relations-Rep-II-Job-LA-71101/2576448/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22785 # Positions 1
Location US-TX-Houston
Search Category Medical Director
Type Regular Full-Time (30+ hours) Posted Date 5/7/2013
Additional Locations ..

More information about this job:
Summary:

AMERIGROUP CORPORATION

MEDICAL DIRECTOR BEHAVORIAL HEALTH Houston

Amerigroup is a Fortune 500 company serving approximately 2 million members in 14 states. Nationwide, we serve one out of every 35 Medicaid recipients and one out of every 25 kids covered by CHIP.

We improve access to quality health care for our members while lowering costs for taxpayers. We coordinate services for individuals in publicly funded health care programs.

Amerigroup accepts all eligible people regardless of age, sex, race or disability.

Our product offerings do not utilize any individual underwriting nor deny coverage due to pre-existing medical conditions. Amerigroup is dedicated to offering real solutions that improve health care access and quality for its members, while proactively working to reduce the overall cost of care to taxpayers.

JOB SUMMARY

Oversees all behavioral health care for AMERIGROUP products and services in Houston. Oversees the health care needs of the membership and serves as the principal behavioral health manager and policy advisor to the company and health plan CEO or COO. Is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with other plan functions that interface with behavioral health management such as medical management, provider relations, member services, benefits and claims management, etc. Assists in short and long range program planning, total quality management (quality improvement) and external relationships. Works with Corporate Health and Medical Affairs for support, assistance and direction in overall behavioral health management effectiveness. Reports all issues of clinical quality management to the health plan CEO, COO, the Board and the Chief Medical Officer (CMO) of AMERIGROUP Corporation. Collaborates with the CMO, the National Medical Director of Behavioral Health and other health plan medical directors on national medical policies and carries out national medical policies at the health plan in collaboration with the health plan CEO or COO

Responsibilities:

1. Assists in managing medical costs and assuring appropriate health care delivery for Amerigroup health plans, products and services.

2. Provides guidance, support and leadership for utilization management activities.

3. Supports Medical Director(s) in all aspects of utilization, quality and network management.

4. Provides support to nurses and clinical leaders in pre-authorization, concurrent and retrospective review decisions, case management and disease management decisions.

5. Assists Medical Directors and/or National Medical Directors with medical policy; participates in policy review, reviews trends and makes recommendations; may plan, organize and/or direct medical services programs, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.

6. Assists in the design and implementation of corrective action plans to address issues and improve plan and network managed care performance.

7. Supports URAC, AHCA and NCQA qualification activities. Prepare for site visits and responds to accrediting and regulatory agency feedback.

8. Participates in risk management, claims adjudication, utilization management, catastrophic case review, education and outreach programs, HEDIS reporting, credentialing, peer to peer review, appeals review, denials, etc.

9. Participates in the development of strategic planning for existing and expanding business. Recommends changes in program content in concurrence with changing markets and technologies.

10. Other duties as assigned or requested.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:

Medical Doctor with specialization and board certification in Psychiatry. - Continuing education to remain current in behavioral health and management areas. - Any equivalent combination of education and experience. Years and Type of Experience Required: Required: - Five years of clinical experience in the practice of medicine, two of which have been in medical and/or health administration. - Three to five years of management and /or clinical experience in a managed care environment. Certifications or Licensure Required: •Board Certified in Psychiatry. - Must be licensed in the state of Texas as a Doctor of Medicine or be able to achieve such licensure upon hire- Active license to practice medicine without restriction issued by the State Board of Licensure or the State Board of Examiners. Preferred: - Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management desired but not required. Other Required: - Management skills to meet the organizational goals. - Must possess excellent communications skills to interface with providers, staff, and management. - Knowledge of behavioral health, quality improvement and UM practices in a managed care environment. - Knowledge of regulatory and accreditation agencies and requirements. - Able to manage multiple priorities and deadlines in an expedient and decisive manner. - Able to manage difficult peer situations arising from medical care review. - 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 travel on common carriers and to adhere to AMERIGROUP’s travel policies. - Must be able to operate a motor vehicle. - Must be able to conduct and participate in meetings

Preferred:
- Board Certification in Addictionology or substantial clinical experience in substance use disorders OR Child Psychiarty
- Masters in Public Health, MBA or MA.
- Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management

Language Skills

Required:
- English

Functional Competencies
- Think creatively, Innovative
- Understanding of financial and business acumen
- Collaborative team player; active listening skills
- Excellent verbal and written communication skills and ability to build and sustain strong working relationships
- Organizational skills and demonstrated ability to multitask and execute
- Strong people leadership and influencing skills
- Strong project management skills; ability to drive programs and lead change
- Knowledge of medical, quality improvement and utilization management practices in a managed care environment
- Knowledge of regulatory and accreditation agencies and requirements
- 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.
- Ability to read, comprehend and interpret complex information and trends to provide accurate and appropriate information to business partners and/or customers.
- Ability to research information using available resources and determine where gaps in information exist to seek other sources.

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

CB1

ermEL
]]>Tue, 07 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Medical-Director-Behavorial-Health-Job-TX-77001/2585343/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Medical-Director-Behavorial-Health-Job-TX-77001/2585343/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22834 # Positions 1
Location US-NATIONWIDE
Search Category Legal
Type Regular Full-Time (30+ hours) Posted Date 5/13/2013
Additional Locations ..

More information about this job:
Summary:

The position is responsible for the regulatory compliance activities of AMERIGROUP’s Medicare Advantage(“MA”), Special Needs Plan (“SNP”), and Part D Prescription Drug (“PD”) product offerings The Compliance Analyst focuses on AMERIGROUP and its delegated vendor’s, first tier, and downstream related entities compliance with the regulatory/contractual obligations of the Centers for Medicare and Medicaid Services (“CMS”) and multiple state regulatory bodies, as well as oversight of the MAPD and SNP product requirements and deliverables.

Responsibilities:

1. Support the oversight of the federal and state regulatory compliance programs and activities for AMERIGROUP’s SNP and MA-PD products:
- Provide management with information for strategic planning.
- AMERIGROUP liaison with CMS and applicable state agencies, serving as “account manager.”
- Maintain productive working relationships with key regulators charged with AMERIGROUP contract administration that leads to a collaboration benefiting company operations and activity.
- Subject matter expert on Medicare Advantage and Part D requirements and programs.

2. Assess, communicate and ensure associate understanding of federal regulations, legislation and CMS Operational Manuals and Memorandums that impact business activity and operations.

3. Maintain resource tools identifying SNP and MA-PD requirements for internal education, and compliance assessments.

4. Conduct onsite and/or desktop audits of all delegated vendors and ensure compliance with training requirements for all applicable contractors.

5. Manage schedule of both internal areas and delegated vendors, ensure all corrective actions are implemented, and ensure all audits are conducted on time and thoroughly.

6. Participate in AMERIGROUP and vendor preparations for multiple SNP and MA-PD performance assessments, CMS audits, and Program Integrity Audits:
- Assist in preparing AMERIGROUP and vendor operational leads for targeted audit activity.
- Coordinate and organize desk review submissions and on-site audit materials.
- Participate in on-site assessment and audit activity.
- Facilitate development of corrective action plans (“CAPs”) and oversee CAP implementation.
- Interact with audit and enforcement agencies to correct deficiencies and minimize CMS administrative actions and sanction activity. Manage submissions of regulatory deliverables and monitor CMS management reports.

7. Responsible for the review and submission of CMS Part C and D reporting to ensure compliance with CMS requirements.

8. Manage regulatory filings and approvals of marketing/advertising materials, member correspondence and outreach programs through CMS HPMS system.
- Review collateral materials via Collateral Material Approval Process;
- Negotiate approvals by CMS and state agency liaisons.

9. Participate in SNP and MA-PD product expansion and new market activities via project management of regulatory document preparation, submission and federal/state approvals.
- Define regulatory requirements and maintain project plan and document tracking system.
- Identify/attain agreement on business owner accountability for deliverables.
- Guide project team members to ensure project deliverables are met, disconnects identified and resolutions achieved.
- Department implementation lead. 10. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High School Diploma with 3 years relevant work experience.

Preferred:
- Bachelor’s Degree.

Years and Type of Experience Required:

Required:
- Minimum of 3 years experience working in regulatory operations of a Medicare Advantage (Medicare+Choice) plan
- Knowledge of federal HMO and Medicare Managed care regulations

Specific Technical Skills

Required:
- Intermediate level Microsoft Office Suite skills.
- Specifically Word and Excel.

Other:

Required:
- Strong analytical and organizational skills.
- Strong verbal and written communication skills.
- Ability to analyze, interpret, and summarize contracts, regulations, policies/procedures, reports and legal documents.
- Ability to respond to questions/concern from internal customers and regulatory agencies present company position in understandable and unambiguous manner.
- Ability to identify root cause, recommend options and implement/negotiate appropriate solutions.
- 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.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer and a telephone.
- Must be able to access/operate filing systems.
- Must be able to conduct, facilitate, and actively participate in meetings.
- Periodic travel required - must be able to travel on common carrier.

ermCorp
]]>Mon, 13 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Compliance-Analyst-Medicare-%28position-located-in-Virginia-Beach%29-Job/2594751/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Compliance-Analyst-Medicare-%28position-located-in-Virginia-Beach%29-Job/2594751/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2012-21352 # Positions 1
Location US-TN-Nashville
Search Category Health Care Operations
Type Regular Full-Time (30+ hours) Posted Date 12/3/2012
Additional Locations ..

More information about this job:
Summary:

Responsible for developing and expanding AMERIGROUP physician, physician group, IPA, hospital and ancillary networks. Responsible for negotiating reimbursement methodologies and contract language in existing and expansion markets. Ensure that all contracts meet AMERIGROUP standards, including feasibility of administration and reimbursement parameters. Support in the development of external recruitment provider materials.

Responsibilities:

1. Coordinate the management and growth of the hospital relations program or ancillary network that is in line with the health plan’s goals.

2. Coordinate with various departments to effectively implement and manage hospital relations or ancillary network development strategy.

3. Monitor hospital or ancillary network concerns, issues, and business opportunities and work with other functional areas of the Health Plan and Home Office regarding resolutions.

4. Management of Advocacy/Education Process with hospitals and ancillary networks including:
- Financial/Operational analysis regarding contract structure;
- Right-sizing of the ancillary provider network with providers that provide cost effective, quality services to AMERIGROUP members at the least administrative cost that meet contract requirements;
- Develop and implement processes/systems that ensure that hospitals and ancillary providers’ claims are paid accurately, timely, and on first submission;
- Coordination of all processes pertaining to contract implementation/maintenance.
- Coordination of market expansion initiatives;
- Negotiation of financial terms and contract language.

5. Identify quality-based, cost efficient processes and lead efforts to gain acceptance and ensure effective implementation.

6. Serve as key contact for targeted hospitals and other providers to ensure effective communication and response mechanisms.

7. Monitor national trends and local Health Plan market trends relative to Provider contracting, reimbursement, and service, make recommendations to modify current processes and assist to implement changes, when necessary.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s Degree in business administration, healthcare administration, or a related field or equivalent experience.

Years and Type of Experience Required:

Required:
- 5 years experience in a healthcare environment, preferably managed care with at least 1 year of leadership/management experience.
- Specific experience in network development, analysis, and contracting.
- Strong understanding of the healthcare industry, managed care, and provider financing.
- Experience contracting with large, complex provider organizations.
- Documented success in provider contracting, recruitment, retention, and service.

Preferred:
- Knowledge of Medicaid reimbursement and methodologies.

Specific Technical Skills

Required:
- Knowledge of hospital organizational structure including integrated delivery system, PHO’s IPA and Group Practices.
- Computational and analytical skills related to Provider contracting and healthcare cost management.
- Excellent computer skills including MS Office and Access.

Certifications or Licensures

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

Other:

Required:
- Excellent verbal and written communication skills.
- Excellent management skills.
- Strong analytical abilities.
- Proven project management skills with a demonstrated ability to manage multiple projects and meet deadlines.
- Appreciation of cultural diversity and sensitivity toward target population.
- Respect for and ability to work well with all levels of the organization and with the Provider Community.
- Ability to establish strategic vision, set expectations and provide clear direction to individuals or departments being managed.
- Understanding of the legal and regulatory environment relative to Provider Relations.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer.
- Must be able to operate a telephone.
- Must be able to travel on common carrier and adhere to AMERIGROUP’s travel policies.

ermHO
]]>Fri, 03 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Nashville-Manager-Contracting-Plan-Job-TN-37201/2304825/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Nashville-Manager-Contracting-Plan-Job-TN-37201/2304825/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
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.


]]>Mon, 06 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Public-Relations-Specialist-Job-VA-23450/2582910/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Public-Relations-Specialist-Job-VA-23450/2582910/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-21689 # Positions 1
Location US-KS-Overland Park
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/1/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

1. Responds to telephonic and written inquiries from providers.

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

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

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

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

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

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

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

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

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

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

12. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Preferred:
- BA/BS degree preferred or equivalent experience.

Years and Type of Experience Required:

Preferred:
- 3-5 years of managed care experience, preferably in a Medicaid environment.

Specific Technical Skills

Required:
- Experience with computer software applications including Excel.
- Claims experience/knowledge of medical coding.

Other:

Required:
- Excellent verbal and written communication skills.
- Detail-oriented.
- Ability to handle multiple tasks.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer, telephone and fax machine.

CB2

ermCS
]]>Fri, 17 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Overland-Park-Provider-Relations-Rep-I-Job-KS-66062/2373325/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Overland-Park-Provider-Relations-Rep-I-Job-KS-66062/2373325/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22578 # Positions 1
Location US-TX-Houston
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 4/15/2013
Additional Locations ..

More information about this job:
Summary:

Serves as liaison to providers and is responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers. These activities include responding to inquiries from providers to clarify issues related to member benefits, claim resolution, appeal status, provider recruitment, and authorization or referral information. May perform position requirements in the field or telephonically, as appropriate. Successful candidates must currently resided in or be willing to relocate to the Houston area.

Responsibilities:

1. Responds to telephonic and written inquiries from providers.

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

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

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

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

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

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

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

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

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

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

12. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Preferred:
- BA/BS degree preferred or equivalent experience.

Years and Type of Experience Required:

Preferred:
- 3-5 years of managed care experience, preferably in a Medicaid environment.
- Bilingual Spanish/English

Specific Technical Skills

Required:
- Experience with computer software applications including Excel.
- Claims experience/knowledge of medical coding.

Other:

Required:
- Excellent verbal and written communication skills.
- Detail-oriented.
- Ability to handle multiple tasks.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer, telephone and fax machine.

ermCS
]]>Tue, 14 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Provider-Relations-Rep-I-Job-TX-77001/2546973/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Provider-Relations-Rep-I-Job-TX-77001/2546973/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22721 # Positions 1
Location US-LA-Metairie
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 5/1/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

1. Responds to telephonic and written inquiries from providers.

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

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

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

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

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

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

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

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

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

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

12. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Preferred:
- BA/BS degree preferred or equivalent experience.

Years and Type of Experience Required:

Preferred:
- 3-5 years of managed care experience, preferably in a Medicaid environment.

Specific Technical Skills

Required:
- Experience with computer software applications including Excel.
- Claims experience/knowledge of medical coding.

Other:

Required:
- Excellent verbal and written communication skills.
- Detail-oriented.
- Ability to handle multiple tasks.

PHYSICAL REQUIREMENTS
- Must be able to operate a computer, telephone and fax machine.

ermCS
]]>Wed, 01 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Metairie-Provider-Relations-Rep-I-Job-LA-70001/2576447/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Metairie-Provider-Relations-Rep-I-Job-LA-70001/2576447/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
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.


]]>Tue, 14 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Manager-Proposal-Writing-&-Editing-Job-VA-23450/2597180/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Manager-Proposal-Writing-&-Editing-Job-VA-23450/2597180/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22891 # Positions 1
Location US-VA-Norfolk
Search Category Pharmacy
Type Regular Part-Time (20-29 hours) Posted Date 5/17/2013
Additional Locations ..

More information about this job:
Summary:

Member of a team dedicated to supporting the HCMS Call Center and administering the Amerigroup Pharmacy and Behavioral Health programs. Interacts internally and externally with pharmacists, providers, and members to process prior authorizations or pre-certification requests using clinical protocols (i.e., decision trees). Also interacts with the National Call Center in resolving specific member issues related to the Pharmacy or Behavioral Health programs.

This position requires a strong understanding of Pharmacy or Behavioral Health processes and procedures.

Responsibilities:

1. Responsible for member and provider calls related to Amerigroup Pharmacy or Behavioral Health programs.

2. Initiates/completes prior authorization requests via phone; obtains additional information via fax from requesting provider and documents all pre-certification/authorization requests, as well as member encounters, utilizing the appropriate systems or resources and in accordance with documentation standards.

3. Function as a referral source for Members or Providers. Have the ability to access system provider lists and give appropriate network referrals.

4. Work closely with members, providers or community agencies to proactively coordinate access to services utilizing their knowledge of community resources.

5. Coordination, authorization, fulfillment, monitoring or tracking of health care services.

6. Adhere to all state accreditation standards or regulatory guidelines, which include HIPAA guidelines, while maintaining member confidentiality.

7. Adhere to key performance measures including average speed of answer, abandon rate and average talk time as well as productivity and quality measures.

8. Complete/follow up on failed faxes to providers or pharmacies

9. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- High School or GED

Preferred:
- Associate or Bachelor Degree

Years and Type of Experience Required:

Required:
- Minimum of three (3) years customer service experience, with one (1) year experience in pharmacy or a health care operations environment, or
- Minimum of (3) years customer service experience, with one (1) year experience in a call center environment.

Preferred:
- Two (2) years of Health Services, Call Center experience.

Certifications or Licensures

Required:
- NA

Preferred:
- Certified Pharmacy Technician (CPhT)

Language Skills

Required:
- English

Functional Competencies

Required:
- Basic knowledge of MS Office Suite applications, such as Word and Outlook.
- Computer keyboarding skills.
- Good communication skills, both written and verbal.
- Well organized and customer focus.
- Ability to work well with others.

Preferred:
- Bilingual– Spanish is a plus.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

ermHO
]]>Fri, 17 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Norfolk-Pharmacy-Tech-I-Part-time-20-hours%2C-Sat-Sun-12pm-6pm%2C-Mon-Fri-7pm-9pm-Job-VA-23501/2604269/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Norfolk-Pharmacy-Tech-I-Part-time-20-hours%2C-Sat-Sun-12pm-6pm%2C-Mon-Fri-7pm-9pm-Job-VA-23501/2604269/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2012-21534 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 12/20/2012
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 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.

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

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 setting.

Preferred:
- Previous experience with NCQA accreditation and HEDIS reporting.

Certifications or Licensures

Required:
- RN, LCSW, 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
]]>Tue, 21 May 2013 07:59:00 GMThttp://www.amerigroup-jobs.com/job/New-York-AVP-Health-Care-Mgmt-Svcs-Job-NY/2344572/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/New-York-AVP-Health-Care-Mgmt-Svcs-Job-NY/2344572/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
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
]]>Tue, 21 May 2013 08:00:00 GMThttp://www.amerigroup-jobs.com/job/Overland-Park-AVP-Health-Care-Mgmt-Svcs-Behavioral-Health-Job-KS-66062/2559505/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Overland-Park-AVP-Health-Care-Mgmt-Svcs-Behavioral-Health-Job-KS-66062/2559505/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
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
]]>Fri, 26 Apr 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-AVP-Senior-Counsel-Job-VA-23450/2453562/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-AVP-Senior-Counsel-Job-VA-23450/2453562/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS Keywords:
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
]]>Sat, 11 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Nashville-Bilingual-Customer-Care-Representative-TN-37201/2373065/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Nashville-Bilingual-Customer-Care-Representative-TN-37201/2373065/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS Keywords:
Bilingual Spanish, 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.

Position#2013-21678 is located in Houston, TX.
We are recruiting for training classes to start in the second quarter 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:
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
]]>Fri, 17 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Bilingual-Customer-Care-Representative-TX-77001/2373066/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Bilingual-Customer-Care-Representative-TX-77001/2373066/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS Keywords:
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
]]>Fri, 17 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Customer-Care-Representative-TX-77036/2375278/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Customer-Care-Representative-TX-77036/2375278/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS