http://www.amerigroup-jobs.com/feeds/lpn-Virginia-Beach-VA-jobs/ Custom RSS Feed for lpn-Virginia-Beach-VA-jobs Sat, 25 May 2013 07:14:47 GMT en-us /sites/amerigroup/images/banner.gif http://www.amerigroup-jobs.com/feeds/lpn-Virginia-Beach-VA-jobs/ 720
Job ID 2013-22631 # Positions 1
Location US-VA-Virginia Beach
Search Category Human Resources
Type Regular Full-Time (30+ hours) Posted Date 4/18/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

2. Work closely with business partners.

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

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

5. Utilize appropriate methods, techniques, and equipment.

6. Monitor effectiveness of programs and progress of trainees.

7. Support business operations.

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

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

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

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

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- College degree or equivalent experience.

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

Years and Type of Experience Required:

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

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

Specific Technical Skills

Required:
- Working knowledge of Microsoft Office applications.

Certifications or Licensure

Required:
- LPN

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

Other:

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

Preferred:
- Healthcare information systems experience highly desirable.

Travel – Technical Trainers Up to 30%

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

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

ermCorp
]]>Fri, 17 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-Clinical-Trainer-Job-VA-23450/2554485/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-Clinical-Trainer-Job-VA-23450/2554485/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22469 # Positions 1
Location US-MD-Hanover
Search Category Human Resources
Type Regular Full-Time (30+ hours) Posted Date 4/2/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

2. Work closely with business partners.

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

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

5. Utilize appropriate methods, techniques, and equipment.

6. Monitor effectiveness of programs and progress of trainees.

7. Support business operations.

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

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

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

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

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- College degree or equivalent experience.

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

Years and Type of Experience Required:

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

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

Specific Technical Skills

Required:
- Working knowledge of Microsoft Office applications.

Certifications or Licensure

Required:
- LPN

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

Other:

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

Preferred:
- Healthcare information systems experience highly desirable.

Travel – Technical Trainers Up to 30%

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

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

ermCorp
]]>Thu, 02 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Hanover-Clinical-Trainer-Job-MD-21075/2525326/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Hanover-Clinical-Trainer-Job-MD-21075/2525326/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22923 # Positions 1
Location US-GA-Atlanta
Search Category Human Resources
Type Regular Full-Time (30+ hours) Posted Date 5/21/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

2. Work closely with business partners.

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

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

5. Utilize appropriate methods, techniques, and equipment.

6. Monitor effectiveness of programs and progress of trainees.

7. Support business operations.

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

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

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

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

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- College degree or equivalent experience.

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

Years and Type of Experience Required:

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

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

Specific Technical Skills

Required:
- Working knowledge of Microsoft Office applications.

Certifications or Licensure

Required:
- LPN

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

Other:

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

Preferred:
- Healthcare information systems experience highly desirable.

Travel – Technical Trainers Up to 30%

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

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

ermCorp
]]>Tue, 21 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Atlanta-Clinical-Trainer-Job-GA-30301/2609153/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Atlanta-Clinical-Trainer-Job-GA-30301/2609153/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22141 # Positions 1
Location US-VA-Norfolk
Search Category Customer Service
Type Regular Full-Time (30+ hours) Posted Date 3/14/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

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

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

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

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

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

12. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Years and Type of Experience Required:

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

Certifications or Licensures

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

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

Language Skills

Required:
- English

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

PHYSICAL REQUIREMENTS

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

ermCS
]]>Sat, 11 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Norfolk-Sr-Medical-Coding-Analyst-Job-VA-23501/2480267/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Norfolk-Sr-Medical-Coding-Analyst-Job-VA-23501/2480267/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22698 # Positions 1
Location US-MD-Hanover
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/26/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Obtains an accurate member history, conducts an assessment of biopsychosocial factors, and assesses clinical information to develop care plans including a member support system. 2. Establishes prioritized short and long term goals in collaboration with the member that meet the member’s needs and the referral source’s requirements. 3. Establishes working relationships with referral sources and community resources. 4. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team. 5. Collaborates with the member’s PCP and specialists in the development of the plan of care to ensure that members’ physical needs are addressed; communicates care objectives to appropriate individuals/departments/referral sources. 6. Provide case management and/or disease management services to members, as identified by a health plan’s referral process. 7. May be required to conduct field visits. 8. May be required to perform service authorization duties using prescribed criteria and responsibilities as assigned and required by the Plan 9. Acts as an advocate for an individual’s health care needs. 10. Reviews benefit systems and cost benefit analysis; evaluates the quality and necessity of applicable services; identifies members that would benefit from an alternative level of care; acquires data and evaluates necessary health services for cost containment; documents effectiveness of case management services 11. Participates in Quality Improvement processes and serves on internal and external committees as required. 12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE: Education Required: - Nursing Diploma - Associate’s Degree in related Health/Nursing field Preferred - Bachelor’s or Master’s Degree in related Health/Nursing field Years and Type of Experience Required: Required: - Minimum of three years clinically related experience Preferred: - Experience working on the community level and with community agencies - Experience in managed care, case management and discharge planning Certifications or Licensures Required: - Active licensed LPN/LVN, LSW or LCSW, LMSW, LMHC, LPC, NP, PA as required by state contract - Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area - Will be required to complete the AGP internal IGCM Certification within the first 18 months of employment Preferred: - Certified Case Manager Language Skills Required: - English Preferred: - Bilingual Functional Competencies - Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems. - Experience working with utilization management data systems SCOPE INFORMATION # Direct Reports: N/A # Indirect Reports: N/A Budgetary $ Responsibility: N/A PHYSICAL REQUIREMENTS: The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. - Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices. - Ability to communicate both in person and/or by telephone. - Must be able to travel as needed and adhere to Amerigroup travel policies and procedures

CB1

ermHO
]]>Fri, 26 Apr 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Hanover-Case-Manager-Pediatric-Job-MD-21075/2569054/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Hanover-Case-Manager-Pediatric-Job-MD-21075/2569054/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22013 # Positions 1
Location US-NY-New York
US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 2/13/2013
Additional Locations US-NY-New York

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

7. May be required to conduct field visits.

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

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

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

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

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

Required:
- Minimum of three years clinically related experience.

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

Certifications or Licensures

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

Preferred:
- Certified Case Manager

Language Skills

Required:
- English

Preferred:
- Bilingual

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Sat, 11 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/New-York-Utilization-Manager%2C-LPN-Outpatient-Job-NY/2428086/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/New-York-Utilization-Manager%2C-LPN-Outpatient-Job-NY/2428086/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22679 # Positions 1
Location US-KS-Overland Park
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 4/25/2013
Additional Locations ..

More information about this job:
Summary:

Manages and oversees team responsible for coordination of a comprehensive health care program in which members’ needs are identified, including physical health, behavioral health, social services and long term service and supports (LTSS)

Responsibilities:

1. Manages and evaluates team’s performance, including preparation of team and individual metrics, and ensures adherence to departmental standards.

2. Manages resource utilization to ensure appropriate delivery of care to members, adequate coverage for all departmental tasks and job responsibilities; monitors telephone queue to ensure adequate coverage while incorporating QA measures and providing appropriate feedback and counseling

3. Provides guidance, feedback and training to team members facilitating the understanding of regulatory and compliance requirements.

4. Coordinates service delivery to include member assessment of physical and psychological factors.

5. May complete member Assessments; assesses members’ present level of physical/mental impairment utilizing defined criteria and methodology, coordinates the identifications of members with potential for high risk complications.

6. Participates in various cross-functional workgroups created to maintain / develop program, including developing agenda items, conducting meetings, and publishing accurate minutes to record workgroup activities / decisions.

7. Evaluates current processes of all clinical support functions; determines and recommends changes for increased efficiencies and improved outcomes.

8. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in related discipline Years and Type of Experience Required:

Required:
- Minimum of 5+ years’ relevant work experience and at least 1 year of leadership/management experience.
- Leadership Development Program in lieu of years of experience.

Preferred:
- Experience in a managed care setting with direct experience in service delivery coordination, discharge planning, or behavioral health.
- Experience working in the community with community agencies.

Certifications or Licensures

Required:
- N/A

Preferred:
- RN, LSW, LPN/LVN

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
- Analyze, incorporates and applies new information and concepts.
- Makes timely decisions on problems/issues requiring immediate attention.

SCOPE INFORMATION

# Direct Reports: 4-15

# Indirect Reports: 0

Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS

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

ermHO
]]>Fri, 24 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Overland-Park-Mgr-LTSS-Plan-Job-KS-66062/2566928/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Overland-Park-Mgr-LTSS-Plan-Job-KS-66062/2566928/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22918 # Positions 1
Location US-KS-Overland Park
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 5/21/2013
Additional Locations ..

More information about this job:
Summary:

This position will telecommute from the Southeast Corner of Kansas.

Manages and oversees team responsible for coordination of a comprehensive health care program in which members’ needs are identified, including physical health, behavioral health, social services and long term service and supports (LTSS)

Responsibilities:

1. Manages and evaluates team’s performance, including preparation of team and individual metrics, and ensures adherence to departmental standards.

2. Manages resource utilization to ensure appropriate delivery of care to members, adequate coverage for all departmental tasks and job responsibilities; monitors telephone queue to ensure adequate coverage while incorporating QA measures and providing appropriate feedback and counseling

3. Provides guidance, feedback and training to team members facilitating the understanding of regulatory and compliance requirements.

4. Coordinates service delivery to include member assessment of physical and psychological factors.

5. May complete member Assessments; assesses members’ present level of physical/mental impairment utilizing defined criteria and methodology, coordinates the identifications of members with potential for high risk complications.

6. Participates in various cross-functional workgroups created to maintain / develop program, including developing agenda items, conducting meetings, and publishing accurate minutes to record workgroup activities / decisions.

7. Evaluates current processes of all clinical support functions; determines and recommends changes for increased efficiencies and improved outcomes.

8. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor’s degree in related discipline Years and Type of Experience Required:

Required:
- Minimum of 5+ years’ relevant work experience and at least 1 year of leadership/management experience.
- Leadership Development Program in lieu of years of experience.

Preferred:
- Experience in a managed care setting with direct experience in service delivery coordination, discharge planning, or behavioral health.
- Experience working in the community with community agencies.

Certifications or Licensures

Required:
- N/A

Preferred:
- RN, LSW, LPN/LVN

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
- Analyze, incorporates and applies new information and concepts.
- Makes timely decisions on problems/issues requiring immediate attention.

SCOPE INFORMATION

# Direct Reports: 4-15

# Indirect Reports: 0

Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS

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

CB:1

ermHO
]]>Tue, 21 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Overland-Park-Mgr-LTSS-Southeast-Region-Kansas-%28Telecommuter%29-Job-KS-66062/2609152/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Overland-Park-Mgr-LTSS-Southeast-Region-Kansas-%28Telecommuter%29-Job-KS-66062/2609152/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22255 # Positions 1
Location US-TX-Houston
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/16/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective care management, utilization of health, mental health, and substance abuse services. Successful candidates must currently resided in or be willing to relocate to the Houston area.

Responsibilities:

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

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

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

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

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

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

7. Review benefit systems and cost benefit analysis.

8. Evaluates the member against level of care criteria.

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

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

Certifications or Licensures

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

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

Language Skills

Required:
- English

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

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: N/A

Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS

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

ermHO
]]>Wed, 08 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Mgr-Health-Care-Mgmnt-Services-Job-TX-77001/2472810/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Mgr-Health-Care-Mgmnt-Services-Job-TX-77001/2472810/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22533 # Positions 1
Location US-TN-Nashville
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 4/9/2013
Additional Locations ..

More information about this job:
Summary:

Partner with health plan departments and Medical Director(s) as well as the associated health plan and corporate personnel to integrate case management services and population-specific health coaches into the Medical Home. Supports the Medical Home’s capacity to provide individual care coordination and complex case management by the primary care practice.

Responsibilities:

1. Provide guidance in assessing the level and type of clinical care management services required by the Medical Home member.

2. Serve as a subject matter expert on health care projects, providing coaching and support to staff assigned to the project.

3. Recognize and evaluate clinical care gaps of the designated Medical Home members.

4. Collaborate with the Medical Home (MH) staff and Medical Practice Consultant (MPC) to create appropriate clinical intervention programs based upon the clinical complexities of the MH member and provide clinical guidance and direction to the Health Plan Case Management team to execute on identified programs.

5. Establish deliverables and monitor progress for each clinical care management plan that supports the specific identified clinical care gaps.

6. Suggest and encourage the use of appropriate community based member visitations and resources as integral to the care management process.

7. Utilize data sharing and routine reports (i.e. CI3, daily census, HEDIS, ER census, Provider Quality Incentive Program) to support the design and management of member specific care plans, a communication plan for progress updates, and opportunities to integrate a quality outcome strategy.

8. May manage a member caseload and/or travel to project sites as appropriate.

9. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

Required:
- Minimum of five years relevant work experience.

Preferred:
- Experience in health services program development, administration, and evaluation.
- Experience working on the community level and with community agencies.
- Experience in managed care, case management and discharge planning Certifications or Licensures (as defined by specific program needs).

Required:
- Active licensed RN, LPN/LVN, LSW or LCSW, LMSW, NP, LPC, PA, CRNP

Preferred:
- Certified Case Manager

Language Skills

Required:
- English

Preferred:
- Bilingual

Functional Competencies
- Working knowledge in a windows environment (MS Word, Excel, Outlook, PowerPoint) to include navigation skills using a mouse and keyboard including 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 apply creative/breakthrough methodologies and thinking to the tasks.
- Strong communication skills, written and verbal; articulate, persuasive & influential; systematic and timely.

PHYSICAL RESPONSIBILITIES

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
]]>Wed, 08 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Nashville-Clinical-Liaison-Job-TN-37201/2537799/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Nashville-Clinical-Liaison-Job-TN-37201/2537799/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22592 # Positions 1
Location US-GA-Atlanta
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/15/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

7. Review benefit systems and cost benefit analysis.

8. Evaluates the member against level of care criteria.

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

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

Certifications or Licensures

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

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

Language Skills

Required:
- English

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

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: N/A

Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS

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

ermHO
]]>Tue, 14 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Atlanta-Manager-Health-Care-Management-Services-Job-GA-30301/2546965/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Atlanta-Manager-Health-Care-Management-Services-Job-GA-30301/2546965/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22584 # Positions 1
Location US-MD-Hanover
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/15/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

7. Review benefit systems and cost benefit analysis.

8. Evaluates the member against level of care criteria.

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

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

Certifications or Licensures

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

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

Language Skills

Required:
- English

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

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: N/A

Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS

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

CB1

ermHO
]]>Tue, 14 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Hanover-Manager%2C-Case-Management-Job-MD-21075/2546971/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Hanover-Manager%2C-Case-Management-Job-MD-21075/2546971/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22680 # Positions 1
Location US-KS-Overland Park
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/25/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

7. May be required to conduct field visits.

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

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

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

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

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Behavioral Health Caser Managers Only:
- Master’s Degree in Behavioral Health field

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

Years and Type of Experience Required:

Required:
- Minimum of three years clinically related experience.

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

Certifications or Licensures

Required:
- Active licensed LPN/LVN, LSW or LCSW, LMSW, LMHC, LPC, NP, PA as required by state contract.
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.
- Will be required to complete the AGP internal IGCM Certification within the first 18 months of employment.

Preferred:
- Certified Case Manager

Language Skills

Required:
- English

Preferred:
- Bilingual

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

PHYSICAL REQUIREMENTS

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

CB:1

ermHO
]]>Fri, 24 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Overland-Park-Case-Manager-Behavioral-Health-Job-KS-66062/2566934/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Overland-Park-Case-Manager-Behavioral-Health-Job-KS-66062/2566934/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22671 # Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/8/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

7. May be required to conduct field visits.

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

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

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

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

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

Behavioral Health Caser Managers Only:
- Master’s Degree in Behavioral Health field

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

Years and Type of Experience Required:

Required:
- Minimum of three years clinically related experience.

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

Certifications or Licensures

Required:
- Active licensed LPN/LVN, LSW or LCSW, LMSW, LMHC, LPC, NP, PA as required by state contract.
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.
- Will be required to complete the AGP internal IGCM Certification within the first 18 months of employment.

Preferred:
- Certified Case Manager

Language Skills

Required:
- English

Preferred:
- Bilingual

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Wed, 08 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/New-York-Case-Manager-Health-Homes-Job-NY/2587600/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/New-York-Case-Manager-Health-Homes-Job-NY/2587600/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22839 # Positions 1
Location US-TX-Houston
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/13/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective care management, utilization of health, mental health, and substance abuse services. Successful candidates must currently resided in or be willing to relocate to the Houston area.

Responsibilities:

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

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

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

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

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

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

7. Review benefit systems and cost benefit analysis.

8. Evaluates the member against level of care criteria.

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

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

Certifications or Licensures

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

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

Language Skills

Required:
- English

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

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: N/A

Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS

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

ermHO
]]>Mon, 13 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Mgr-Health-Care-Mgmnt-Services-%28OBPEDI%29-Job-TX-77001/2594749/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Mgr-Health-Care-Mgmnt-Services-%28OBPEDI%29-Job-TX-77001/2594749/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22897 # Positions 1
Location US-KS-Overland Park
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/17/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

7. Review benefit systems and cost benefit analysis.

8. Evaluates the member against level of care criteria.

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

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

Certifications or Licensures

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

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

Language Skills

Required:
- English

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

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: N/A

Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS

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

CB:1

ermHO
]]>Fri, 17 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Overland-Park-Mgr-Health-Care-Mgmnt-Services-Utilization-Review-Inpatient-Job-KS-66062/2604274/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Overland-Park-Mgr-Health-Care-Mgmnt-Services-Utilization-Review-Inpatient-Job-KS-66062/2604274/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22886 # Positions 1
Location US-TX-Houston
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/17/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective care management, utilization of health, mental health, and substance abuse services. Successful candidates must currently resided in or be willing to relocate to the Houston area.

Responsibilities:

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

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

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

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

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

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

7. Review benefit systems and cost benefit analysis.

8. Evaluates the member against level of care criteria.

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

10. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

Certifications or Licensures

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

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

Language Skills

Required:
- English

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

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: N/A

Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS

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

ermHO
]]>Fri, 17 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Mgr-Health-Care-Mgmnt-Services-Utilization-Management-Job-TX-77001/2604275/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Mgr-Health-Care-Mgmnt-Services-Utilization-Management-Job-TX-77001/2604275/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22924 # Positions 1
Location US-TN-Nashville
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/21/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

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

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

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

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

6. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

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

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

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of three years experience in health care, case management, discharge planning, utilization management, or behavioral health.
- Experience working on the community level and with community agencies.

Certifications or Licensures

Required:
- LPN, LVN or LSW (depending on health plan needs or as mandated by state contract).
- Must possess a valid driver’s license and access to a motor vehicle.
- For Behavioral Health Dept/Specialty Requirements only: LMFT, LPC, LCSW.

Preferred:
- Certified Professional Healthcare Management.

Language Skills

Required:
- English

Preferred:
- Bilingual

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Tue, 21 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Nashville-Utilization-Manager-Job-TN-37201/2609154/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Nashville-Utilization-Manager-Job-TN-37201/2609154/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22937 # Positions 1
Location US-GA-Atlanta
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 5/22/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of all acute and sub acute services for appropriateness based on medical criteria, the management of healthcare resources necessary and appropriate for achievement of desired acute and sub acute outcomes, and the coordination of alternative levels of care for members. Serves as a patient advocate, seeking and coordinating creative solutions to patients’ health care needs without compromising quality outcomes.

Responsibilities:

1. Performs on-site and/or telephonic review of acute and sub acute services.

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

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

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

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

6. Participates in Quality Improvement Process; tracks and reports trends of inappropriate utilization of resources to the Medical Director; identifies and reports any quality or utilization issues to the Medical Director.

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

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

9. Participates in rounds with the Medical Director.

10. Reviews health plan appeal items for concurrent and retrospective reviews as required and requested.

11. Monitors and facilities appropriate utilization of resources using appropriate clinical criteria.

12. Participates in a multi-disciplinary clinical team to achieve positive member outcomes; Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

Required:
- Minimum of two years of utilization management or hospital/acute care experience.

Preferred:
- Minimum of three years experience in health care, case management, discharge planning, utilization management, or behavioral health.
- Experience working on the community level and with community agencies.

Certifications or Licensures

Required:
- LPN, LVN or LSW (depending on health plan needs or as mandated by state contract).
- Must possess a valid driver’s license and access to a motor vehicle.
- For Behavioral Health Dept/Specialty Requirements only: LMFT, LPC, LCSW.

Preferred:
- Certified Professional Healthcare Management.

Language Skills

Required:
- English

Preferred:
- Bilingual

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Wed, 22 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Atlanta-Utilization-Manager-Job-GA-30301/2611292/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Atlanta-Utilization-Manager-Job-GA-30301/2611292/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2012-21327 # Positions 1
Location US-TN-Nashville
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 11/29/2012
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

7. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

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

Certifications or Licensures

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

Language Skills

Required:
- English

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

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Sun, 19 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Nashville-Care-Coordinator-Dickson%2C-Williamson-Job-TN-37201/2299575/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Nashville-Care-Coordinator-Dickson%2C-Williamson-Job-TN-37201/2299575/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS