http://www.amerigroup-jobs.com/feeds/social-worker-case-manager-jobs/ Custom RSS Feed for social-worker-case-manager-jobs Sat, 25 May 2013 17:31:17 GMT en-us /sites/amerigroup/images/banner.gif http://www.amerigroup-jobs.com/feeds/social-worker-case-manager-jobs/ 720
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 2013-22533 # 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 2013-22365 # Positions 2
Location US-FL-Tampa
Search Category Case Management
Type Intern Posted Date 3/22/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

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

Certifications or Licensures

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

Language Skills

Required:
- English

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

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Tue, 07 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Tampa-Case-Manager-Tampa-Temp-Assignment-Job-FL-33601/2496481/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Tampa-Case-Manager-Tampa-Temp-Assignment-Job-FL-33601/2496481/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22931 # Positions 1
Location US-FL-Boca Raton
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 5/22/2013
Additional Locations ..

More information about this job:
Summary:

Responsible for conducting Long Term Care (LTC) New Hire staff training; and ongoing mandatory training of interests to LTC staff. Oversees Annual member Satisfaction Survey, Record Review process; and Performance Measure Report. Assist with DOEA audits and compliance. Also conducts telephonic or face-to-face assessments for the identification, evaluation, coordination and management of Members’ needs, including physical health, behavioral health, social services and long term services and supports; develops the Member’s Individualized Service Plan to address those needs. Establishes relationships with referral sources and community resources, while maintaining strict member confidentiality and complying with all HIPAA requirements.

Responsibilities:

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

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

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

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

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

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

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

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

Certifications or Licensures

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

Language Skills

Required:
- English

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

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Wed, 22 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Boca-Raton-Case-Manager-LTC-Training-Job-FL-33427/2611286/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Boca-Raton-Case-Manager-LTC-Training-Job-FL-33427/2611286/?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 2013-22255 # 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 2013-22886 # 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 2013-22839 # 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 2013-22848 # Positions 1
Location US-FL-Miami Lakes
Search Category Healthcare Management Services
Type Regular Full-Time (30+ hours) Posted Date 5/14/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

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

Certifications or Licensures

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

Language Skills

Required:
- English

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

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

PHYSICAL REQUIREMENTS

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


]]>Tue, 14 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Boca-Raton-Case-Manager-Boca-Raton-Job-FL-33427/2597176/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Boca-Raton-Case-Manager-Boca-Raton-Job-FL-33427/2597176/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22645 # Positions 1
Location US-KS-Overland Park
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 4/22/2013
Additional Locations ..

More information about this job:
Summary:

This position is a telecommuting position located in the Chaunte or Coffeyville area of Kansas. You must reside in this area and cover the distance in your personal vehicle in these areas.

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

Responsibilities:

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

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

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

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

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

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

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

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

Certifications or Licensures

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

Language Skills

Required:
- English

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

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Tue, 21 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Overland-Park-LTSS-Service-Coordinator-Southeast-ChaunteCoffeyville-Telecommuting-Job-KS-66062/2559506/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Overland-Park-LTSS-Service-Coordinator-Southeast-ChaunteCoffeyville-Telecommuting-Job-KS-66062/2559506/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22677 # Positions 1
Location US-KS-Overland Park
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 4/25/2013
Additional Locations ..

More information about this job:
Summary:

This position is a telecommuting position located in the Brown and Doniphan Counties area of Kansas. You must reside in this area and cover the distance in your personal vehicle in these areas.

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

Responsibilities:

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

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

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

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

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

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

7. Perform other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

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

Certifications or Licensures

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

Language Skills

Required:
- English

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

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

PHYSICAL REQUIREMENTS

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

ermHO
]]>Fri, 24 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Overland-Park-LTSS-Service-Coordinator-Northeast-Brown-and-Doniphan-Counties-Only-Telecommuting-Job-KS-66062/2566929/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Overland-Park-LTSS-Service-Coordinator-Northeast-Brown-and-Doniphan-Counties-Only-Telecommuting-Job-KS-66062/2566929/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2012-21492 # Positions 1
Location US-TX-Houston
Search Category Healthcare Management Services
Type Temp/Contractor Posted Date 12/17/2012
Additional Locations ..

More information about this job:
Summary:

Contract clinical staff needed for a medicaid project to support Harris and surrounding Counties.

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.


]]>Wed, 22 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Houston-Contract-RNs%2C-LVNs%2C-or-Licensed-Social-Workers-for-Medicaid-Project-Job-TX-77001/2336650/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-Contract-RNs%2C-LVNs%2C-or-Licensed-Social-Workers-for-Medicaid-Project-Job-TX-77001/2336650/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22187 # Positions 1
Location US-VA-Virginia Beach
Search Category Health Care Administration
Type Regular Full-Time (30+ hours) Posted Date 3/6/2013
Additional Locations ..

More information about this job:
Summary:

The incumbent will serve as the primary clinical leader for Amerigroup’s dual initiative, and will be responsible for the program development, implementation, and management of Utilization Management, Case Management, Disease Management, Audit, Quality Management, Pharmacy Services, Mental Health, and/or Appeals and Grievances. The ideal candidate incumbent has at least 12 years of leadership experience in Medicaid/Medicare medical management (Nursing or Social Work), with Long Term Support Services (LTSS) and medical Geriatric experience, working in a matrix organization.

Responsibilities:

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

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

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

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

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

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

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

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

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

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

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

12. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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

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

Years and Type of Experience Required:

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

Certifications or Licensures

Required:
- RN, LCSW, LPC

Language Skills

Required:
- English

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

SCOPE INFORMATION

# Direct Reports: 5-30

# Indirect Reports: varies

Budgetary $ Responsibility: As assigned

PHYSICAL REQUIREMENTS

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

ermHO
]]>Thu, 16 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Virginia-Beach-VP-Healthcare-Mgmt-Svcs-Job-VA-23450/2467976/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Virginia-Beach-VP-Healthcare-Mgmt-Svcs-Job-VA-23450/2467976/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22293 # Positions 4
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 4/22/2013
Additional Locations ..

More information about this job:
Summary:

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

Spanish bilingual skill set is required.

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.
- 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
]]>Tue, 21 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/New-York-Case-Manager-MLTC-New-York-Bilingual-Spanish-Job-NY/2559502/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/New-York-Case-Manager-MLTC-New-York-Bilingual-Spanish-Job-NY/2559502/?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 2013-22679 # 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 2012-21374 # Positions 1
Location US-TX-Houston
Search Category Healthcare Management Services
Type Regular Full-Time (30+ hours) Posted Date 12/5/2012
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.


]]>Thu, 02 May 2013 03:00:00 GMThttp://www.amerigroup-jobs.com/job/Houston-LTSS-Svc-Coordinator-Clinician-Job-TX-77001/2309771/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-LTSS-Svc-Coordinator-Clinician-Job-TX-77001/2309771/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-21733 # Positions 1
Location US-TX-Houston
Search Category Healthcare Management Services
Type Regular Full-Time (30+ hours) Posted Date 4/24/2013
Additional Locations ..

More information about this job:
Summary:

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

Responsibilities:

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

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

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

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

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

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

7. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

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


]]>Fri, 17 May 2013 02:59:00 GMThttp://www.amerigroup-jobs.com/job/Houston-LTSS-Svc-Coordinator-Clinician-Job-TX-77001/2380756/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Houston-LTSS-Svc-Coordinator-Clinician-Job-TX-77001/2380756/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID 2013-22712 # Positions 1
Location US-TX-Beaumont
Search Category Healthcare Management Services
Type Temp/Contractor Posted Date 4/30/2013
Additional Locations ..

More information about this job:
Summary:

Contract Registered Nurses needed for a medicaid project to support Jefferson County.

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 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.


]]>Wed, 01 May 2013 00:00:00 GMThttp://www.amerigroup-jobs.com/job/Beaumont-Contract-RNs-Medicaid-Project-Job-TX-77657/2575521/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSShttp://www.amerigroup-jobs.com/job/Beaumont-Contract-RNs-Medicaid-Project-Job-TX-77657/2575521/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS