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Job ID: 2010-12102
# Positions: 1
Location: US-TN-Nashville
Search Category: Human Resources
Type: Regular Full-Time (30+ hours)
Posted Date: 8/6/2010

More information about this job:

Overview:

Under direct supervision, perform administrative support to the Human Resources Department including processing/updating data into human resources information/computer system (HRIS) database, maintenance of confidential associate human resources files, and providing information to employees on matters pertaining to their personal employee information.

Responsibilities:

1. Provide general administrative support to the Human Resources team including processing/updating data into human resources information/computer system (HRIS) database, maintenance of confidential associate human resources files, and timely processing of recruitment, benefit, performance management, and other Human Resource-related paperwork. Verify that all forms are completed and all actions taken or requested are consistent with Amerigroup policies and procedures.
2. May assist with recruitment and/or generalist processes to include tasks related to sourcing/screening of resumes, scheduling interviews, exit interviews, offer packages, etc.
3. Facilitate New Hire Orientation sessions to review Company expectations, guidelines, as well as Corporate Policies and procedures
4. Coordinate pre-employment reference and criminal background checks.
5. Update and audit Position Control for designated area(s).
6. Create offer letters/memos for designated area(s).
7. Manage documentation and schedules for unemployment claims, appeals and hearings.

10. Generate ad hoc reports as needed.

11. Administer Educational Assistance including requests for reimbursement.

12. Process all referral, sign-on and retention bonus requests.

13. Assist with coordination of events such as associate recognition/appreciation, holiday events, recruiting events, etc.

14. Serve as back-up to other HR Coordinators/Specialists as required.

15. Provide training to new HR associates, which may involve travel.

16. Perform other duties as requested or assigned.

Qualifications:

Education

Required:

- High school diploma or equivalent

Preferred:

- Bachelor?s degree in related field or equivalent experience

Years and Type of Experience Required:

Required:

- Minimum 5 years of related experience

Specific Technical Skills

Required:

- Excellent computer skills and ability to use Microsoft Office Suite including Word, Excel and Outlook including:

- MS Word Mail Merge functionality
- Manipulation of Excel spreadsheets and understanding of formulas

Preferred:

- Experience working with PeopleSoft

Certifications or Licensures Preferred:

- PHR

Other:

Required:

- Excellent verbal and written communication skills, especially giving and receiving feedback.
- Strong organizational and analytical skills with high level of attention to detail.
- Provide high level of customer service.
- Strong interpersonal skills and ability to use tact and diplomacy.
- Ability to maintain confidentiality.
- Strong presentation skills.
- Dedicated team player, who demonstrates initiative.
- Proven problem solving skills.
- Must be flexible; able to handle multiple projects and changing priorities
- High energy and a positive can-do attitude.
- Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION

# Direct Reports: 0

# Indirect Reports: 0

Budgetary $ Responsibility: N/A

PHYSICAL REQUIREMENTS:

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

- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.]]> http://www.amerigroup-jobs.com/job/Nashville-Sr-HR-Coordinator-Job-TN-37201/902194/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Sr-HR-Coordinator-Job-TN-37201/902194/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12093
# Positions: 16
Location: US-TN-Nashville
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/5/2010

More information about this job:

Overview:

Responsible for responding to either inbound inquiries or outreach calls from/to potential and existing AMERIGROUP members and providers. Responsibilities include providing accurate information/education/resolution about eligibility status, benefit coverage, provider network, credentialing status, authorization/referral status, demographic changes and all other non-claim issues.

Responsibilities:

1. Function as an information source through telephonic assistance to members, providers, billing agencies, and various company/department staff.

2. Provide effective customer care through superior customer service methods, problem solving and real time issue resolution that promotes member and provider retention.

3. Interact with provider community and various departments to resolve issues involving the membership

4. Explain benefits, eligibility status, and member enrollment processing procedures to callers.

5. Assist with activities to ensure membership's continuity of care.

6. Assist providers with credentialing status questions.

7. Verify the status of authorizations and/or referrals

8. Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls) and complete health assessments for plan case management (Early Case Findings and Healthy Beginnings).

9. Process complaints, following established guidelines.

10. Participate in conducting membership surveys.

11. Assist company departments with various tasks (complications) involving the membership.

12. Must become familiar with and maintain knowledge of state guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance.

13. Provide mentoring and support to new associates once proficient.

14. Other duties as assigned.

Qualifications:

Education

Required:

High School Diploma or equivalent

Preferred:

Some college courses or degree.

Years and Type of Experience Required:

Required:

Minimum 2 years experience in customer service and/or call center environment.

Preferred:

Managed care experience.

Specific Technical Skills

Required:

Ability to work independently and use reference material to resolve member's benefit related questions.

Basic computer skills and ability to navigate in Windows environment.

Other:

Required:

Must learn and fully understand the managed care products.

Strong interpersonal skills.

Ability to multitask, demonstrate initiative and respond proactively to resolve problems.

Excellent written and verbal communication skills.

Detail oriented with strong organizational skills.

Self disciplined and self motivated.

Strong problem solving skills.

Ability to handle crisis calls and irate callers calmly and effectively.

Team player.

Appreciation of cultural diversity and sensitivity towards target population.

Ability to demonstrate HIPAA compliance.

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]]> http://www.amerigroup-jobs.com/job/Nashville-Customer-Care-Rep-I-NCC-Job-TN-37201/900728/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Customer-Care-Rep-I-NCC-Job-TN-37201/900728/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12094
# Positions: 2
Location: US-TN-Nashville
Search Category: Nursing
Type: Regular Full-Time (30+ hours)
Posted Date: 8/5/2010

More information about this job:

Overview:

Support the development and implementation of quality improvement interventions and audits and assists in resolving deficiencies that impact on plan compliance to regulatory and accreditation standards. Assignments are somewhat broad in nature, often requiring creativity and originality.

Review appeals/grievances/quality of care issues received in the Quality Management Department requiring assessment of medical records or clinical information to ensure appropriate processing. Analyze the appeal/grievances/quality of care submission, AMISYS/FACET, CAT database, and clinical resources to ensure that the issue is appropriately processed. Assures documentation of the appeal/grievance/quality of care is appropriate, systems are updated to reflect the issue and that the appeal/grievance/quality of care are routed appropriately. Generate letters to providers/appellants to document appeal/grievance/quality of care documentation requests/outcomes are appropriate.

Responsibilities:

1. Investigate and research, gather information, send appeal to Medical Director/ like specialty and resolve appeals with letter generation within standard time frames.

2. Assist in implementation and monitoring of quality studies including, but not limited to the development and implementation of preventive health and chronic disease outcomes improvement interventions such as newsletter article, member education and outreach interventions, provider education and outreach interventions, medical record review, focus studies and surveys

3. Participate and contribute to external reviews site visits preparations by the State, accreditation review, Medical Advisory Committee, and Quality Management Committee

4. Conduct internal monitoring and auditing timeline compliance standards. Assist in action plan/interventions as needed with management

5. Research and summarize credentialing files for Committee review, as assigned

6. Process, track and trend, and report medical necessity appeals, grievances, and quality of care issues by line of business for compliance and review

7. Coordinate with departments including Member Services, Provider Relations, Credentialing, Pharmacy and Claims to resolve provider and member issues related to appeals, grievances, and quality of care issues

1. Organize and prioritize clinical job tasks in order of importance and impact on members and providers

9. Investigate and resolves governmental agency and executive level inquiries/issues

10. Prepare medical files for Appeal Committee, Peer Review Committee, and Fair Hearings

11. Perform monthly, quarterly, annual and ad hoc medial record reviews, as assigned

12. Utilize leadership skills and serves as a subject matter expert for appeals/grievances/quality of care issues and is a resource for clinical and non clinical team members in expediting the resolution of outstanding issues

13. Actively participates in quarterly Plan HIPAA audits

14. Maintains member confidentiality and follow HIPAA guidelines

15. Completes special projects or assignments as needed to meet initiatives and/or objectives of the department

16. Review claims/appeals requiring authorization and/or coding review routed to the department for medical necessity and appropriateness based on approved criteria

17. Process and document claims/appeals in compliance with department standard and state regulations

18. Maintains accurate reporting to assure compliance with departmental standards and policies

19. Adhere to company and department policies and procedures related to claims payment, authorization decisions, and overturn/denial decisions related to appeals

20. Other Duties as Assigned

Qualifications:

Education

Required: Vocational Nursing diploma or A.A. in Nursing

Preferred: BSN

Years and Type of Experience Required:

Required: 3 years of clinical experience

Preferred: 3-5 years in a managed care environment or related field. Demonstrate leadership, strong communication skills

Specific Technical Skills

Required:

Preferred:

Certifications or Licensure

Required: Valid Registered Nurse or Licensed Practical Nurse license

Preferred:

Other

Required: Ability to work on multiple projects and tasks on a daily basis; strong presentation/verbal/writing/listening skills; ability and confidence to make decisions based on the scope of the job; ability to travel within the State; Computer literate including word processing and spreadsheet knowledge; excellent verbal and written communication skills; demonstrate strong decision-making skills; ability to work independently and in groups effectively; appreciation of cultural diversity and sensitivity towards target populations

Preferred:

SCOPE INFORMATION

# Direct Reports

# Indirect Reports

Budgetary $ Responsibility

PHYSICAL REQUIREMENTS

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

- Must be able to sit for long periods of time]]> http://www.amerigroup-jobs.com/job/Nashville-Quality-Operations-Nurse-Job-TN-37201/900729/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Quality-Operations-Nurse-Job-TN-37201/900729/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12089
# Positions: 1
Location: US-TN-Nashville
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/4/2010

More information about this job:

Overview:

Under the limited supervision, the Workforce Analyst analyzes real-time call volume patterns and various agent phone states using a Call Center Management System, and makes necessary skill changes to ensure calls are answered according to established service levels goals. The Workforce Analyst will effectively use a combination of workforce scheduling software and real-time queue management software to achieve service level goals.

Responsibilities:

Monitor real-time call volumes-to-phone associates using the queue management system and the agent schedule adherence application. Take proactive measures to meet call volume demands by adding or reprioritizing skill levels in associates? skill profiles in coordination with appropriate business partners.

Monitor daily service levels, productivity and adherence and alert management of negative performances. Recognize abnormal call variances, research and report findings to the Workforce Management Team.

Identify intervals where there is consistent overstaffing or understaffing and report inefficiencies to Workforce Management team.

Electronically broadcast service level statistical queue performances to senior management and explain events that resulted in outcomes and expound on actions taken to address queue activities, if needed.

Process associates? daily schedule exceptions in the scheduling applications to reconcile scheduled net staffing and associate adherence. Reconcile daily scheduling errors and adherence conflicts in the Scheduling and Adherence system. Generate attendance reports and assist in the assist in the preparation of the next day?s staffing reports.

Schedule ad hoc training and team meeting requests - including adjusting associates? breaks and lunches so that they do not conflict with other scheduled events or jeopardize service levels.

Enter and adjust schedules in the scheduling application, create and edit employee records, schedule meetings, training, process staffing transfers and terminations in related databases.

Process Time Off requests based on established criteria.

Keep Workforce Management systems and databases in synchronization so that when changes are made in one application, there are corresponding changes in supporting applications.

Other duties as assigned.

Qualifications:

Education

Required:

High school diploma or GED.

Preferred:

Associate?s degree in related discipline.

Years and Type of Experience Required:

Required:

Five years in a call center environment or equivalent combination of call center experience and higher education

Preferred:

Minimum of 2 years Call Center Intraday Queue Management experience (logistics or scheduling and planning).[RF1]

Managed Health Care experience.

Specific Technical Skills

Required:

Detail oriented with proven analytical ability, problem identification and escalation skills.

Supports and contributes towards continued process improvements.

Knowledge of call center metrics, agent behaviors and other factors that affect queue and adherence reporting.

Proven ability prioritizing and executing multiple tasks.

Preferred:

Knowledge of ACD/IVRs and call flows.

Experience with ACD reporting software-Call Management System (CMS)

Certifications or Licensures Preferred:

Six Sigma Certification

Member of Society of Workforce Planning Professionals (SWPP)

Other:

Required:

Ability to work in a virtual network, this includes interpersonal negotiations in addition to navigating within web based tools such as Impact 360 and SharePoint.

Proven ability prioritizing and executing multiple tasks.

Good verbal and written communication skills.

Strong customer service values.

Appreciation of cultural diversity and sensitivity towards target populations.

PHYSICAL REQUIREMENTS:

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

Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.

Ability to communicate both in person and/or by telephone.

Must be able to participate in meetings

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

Must be able and willing to work days, evenings or weekends (flexible shifts).

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

[RF1]May want to have other type of experience as an acceptable requirement so that internal associates could qualify for this position.]]> http://www.amerigroup-jobs.com/job/Nashville-Workforce-Analyst-Job-TN-37201/895992/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Workforce-Analyst-Job-TN-37201/895992/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12077
# Positions: 1
Location: US-TN-Nashville
Search Category: Healthcare Management Services
Type: Regular Full-Time (30+ hours)
Posted Date: 8/3/2010

More information about this job:

Overview:

JOB SUMMARY: The AVP of Quality Management provides leadership in the development, coordination, implementation, and evaluation of the continuous quality improvement initiatives throughout the company in the areas of quality of care, quality of service, and provider/member satisfaction. Provides direction, leadership and education for compliance with NCQA standards to achieve and maintain NCQA accreditation. Maintains liaison with state and federal regulatory agencies. Supports health plan coordination of the quality management program across the company by sharing replicable technology, benchmarking, and best practices. Works to establish and promote a culture of organizational excellence.

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Directs and provides leadership for implementing, monitoring and evaluating the Quality Management Program for the health plan ensuring the demographic and epidemiological needs of the population served are met. 2. Establishes objectives and annual goals in conjunction with the CEO and Medical Directors. 3. Oversees implementation and evaluation of the scope of the quality management program. 4. Promotes plan-wide understanding, communication, and coordination of the quality management program. 5. Directs and provides leadership for Plan compliance with NCQA standards. 6. Provides leadership for the interpretation of results and development of improvement action plans arising from provider and member satisfaction surveys. 7. Serves as a resource for design of quality improvement studies, indicators, data collection, and data trend analysis/interpretation. 8. Provides leadership in developing, monitoring, and evaluating HEDIS improvement action plans. 9. Participates in market development activities through due diligence activities. 10. Provides leadership for health plan QM activities through sharing of replicable technology/benchmarking/best practices, assisting with review preparation, and providing guidance in quality improvement activities. 11. Provides coaching for development of QM personnel. 12. Works to establish and promote organizational excellence throughout the health plans. 13. Monitors compliance with State and Federal quality improvement/assurance requirements. 14. Evaluates and makes recommendations for oversight of delegated services. 15. Develops the QM department annual operating and capital budgets to sufficiently meet departmental needs, and ensures the department stays within budget, and accounts for variances. 16. Interviews, manages, evaluates, and develops new and existing departmental staff. 17. Recognizes and utilizes appropriate channels for communication, encourages two-way communication, and encourages staff to participate in creative program development. 18. Effectively communicates information to superiors, team members, and other appropriate staff in a timely, accurate, and courteous manner. 19. Provides leadership/facilitation for groups as needed. 20. Represents Quality Management through group presentations on various topics for a variety of internal and external audiences. 21. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE: Education ' Bachelor Degree required. ' MSN, MPH, MPA preferred. Years and Type of Experience Required: Required: ' Minimum of 10 years experience in quality management, quality improvement, risk management, and/or utilization review in HMO setting and 5 years of leadership/management experience. ' Previous NCQA accreditation and HEDIS reporting experience required. Specific Technical Skills ' Required: Knowledge of basic computers including word processing and spreadsheets. ' Preferred: Knowledge of data base applications preferred. Certifications or Licensure Required:. Preferred: ' Current RN state license (or as required by Plan) ' CPHQ preferred. Other ' Strong knowledge base in areas of quality improvement, accreditation, HEDIS, satisfactory survey process, and organizational improvement. ' Excellent written and verbal communication skills. ' Ability to work effectively with physicians and other health care providers as well as with multi-disciplinary teams across department lines. ' Excellent problem solving skills. ' Demonstrates strong organizational skills. ' Strong leadership, coaching, and staff development skills. ' Ability to develop and give presentations and to facilitate groups. ' Ability to handle multiple tasks. ' Appreciation of cultural diversity and sensitivity towards target population. SCOPE INFORMATION ' # Direct Reports: Will likely have direct reports. ' # Indirect Reports: Will likely have indirect reports. ' Budgetary $ Responsibility: May have budgetary responsibility. PHYSICAL REQUIREMENTS ' Must be able to operate a computer. ' Must be able to operate a phone. ' Must be able to travel on common carriers and to adhere to AMERIGROUP's travel policies]]> http://www.amerigroup-jobs.com/job/Nashville-AVP-Quality-Management-Job-TN-37201/894924/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-AVP-Quality-Management-Job-TN-37201/894924/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-11545
# Positions: 1
Location: US-TN-Nashville
Search Category: Nursing
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010

More information about this job:

Overview:

The HCMS manager is responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services.

Responsibilities:

1. Manages and oversees team responsible in case finding and coordinating those cases that involve comorbid conditions and need to be part of the case management/disease management track.

2. Manages and evaluates teams performance and ensure adherence to departments standards

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

4. Works with providers to establish short and long term goals that meet the members need, functional abilities and referral sources requirements.

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

6. Coordinates the identifications of members with potential for high risk complications.

7. Assesses members present level of physical/mental impairment utilizing defined criteria and methodology.

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

9. Review benefit systems and cost benefit analysis.

10. Evaluates the member against level of care criteria.

11. Demonstrates knowledge of utilization management targets.

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

13. Requests direction from Medical Director on complex healthcare issues.

14. Maintains member confidentiality and respect of the patient bill of rights.

15. Other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:

- Bachelors Degree, or equivalent work experience

Preferred:

- MSN, MPH, MPA, or MSW or related or MBA with Health Care Concentration

Years and Type of Experience Required:

Required:

- Five years experience in health Care Management and at least one year of leadership/management experience.

Knowledge and Technical Skills

Required:

- Knowledge of community resources
- Basic Computer skills to include Microsoft Word and Excel
- Ability to provide supervision to multidisciplinary team
- Strong decision making skills
- Ability to provide services in an environment that involves multiple health, mental health and substance abuse care systems.
- Ability to interact with all relevant components of the health and behavioral health care systems
- Self starter with the ability to handle multiple projects at one time.

Certifications or Licensure

Required:

- RN, or PA, or LSW, or LPC, or LMHC

Preferred:

- Certified Case Manager

SCOPE INFORMATION Item Measure

- # Direct Reports 2-10 (or individual contributor in a coaching/training capacity within the department)
- Budgetary $ Responsibility none

PHYSICAL REQUIREMENTS

- Able to operate a computer
- Able to operate a telephone]]> http://www.amerigroup-jobs.com/job/Nashville-Operations-Business-Analyst-II-Job-TN-37201/866869/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Operations-Business-Analyst-II-Job-TN-37201/866869/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12053
# Positions: 1
Location: US-TN-Nashville
Search Category: Finance
Type: Regular Full-Time (30+ hours)
Posted Date: 7/30/2010

More information about this job:

Overview:

JOB SUMMARY: Works under general supervision gathering requirements, performing analysis, supporting the development and testing processes, and understanding the applications, data, and associated technologies for supported functional areas. Analyze simple to moderately complex business problems to be solved with automated systems.

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Perform requirements gathering, analysis, and process and data flow diagramming for simple processes of low complexity. 2. Assist in the development of functional test plans used to verify specific business system functions according to actual requirements and established guidelines. 3. Evaluate and test simple to moderately complex new/modified programs, applications and/or operating systems to ensure adherence to operational specifications. Document and track product defects. Coordinate problem resolution with development and/or product vendors. 4. Adhere to existing configuration management procedures. 5. Read and interpret a design document. 6. Read and interpret conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts. 7. Resolve simple to moderate design issues. Functions as a liaison for IT and the business. 8. Manage multiple priorities at the same time. 9. Other duties as assigned

Qualifications:

EDUCATION AND EXPERIENCE: Education: Required: ' Bachelor's degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience is acceptable in lieu of a degree(s). Years and Type of Experience Required:: Required: ' A minimum of 2 years experience in business or systems analysis. Preferred: ' In addition to required experience, 1 year experience in healthcare or financial/hr analysis. Specific Technical Skills: Required: ' Demonstrate a basic understanding of core business applications and systems. ' Demonstrate advanced proficiency with applicable business processes, definitions and terminology. ' Demonstrate basic knowledge of the inter-relationship among various managed care operational areas. Demonstrate basic knowledge and skills in one or more of the following managed care business areas: Member Enrollment, Provider Information Management, Claims Processing and Adjudication, Benefits Configuration, and/or Call Center. ' Demonstrate basic understanding of data flows in managed care business processes. ' Demonstrate a basic understanding of infrastructure associated with supported business applications. ' Demonstrate basic understanding of the strategic alignment of IT solutions with business objectives. ' Demonstrate a basic knowledge of current technology trends. ' Able to provide professional and appropriate written and verbal information to internal and external customers. ' Able to initiate conceptual ideas with practical applications. Certifications or Licensure: N/A Other: Required: ' Demonstrate understanding of how unit/team relates to the department. ' Able to develop and maintain customer relationships. ' Able to identify, analyze, and solve problems and to work with teams to solve problems. ' Able to participate in teams as a strong team participant. ' Able to develop and implement basic project plans with direction and supervision. ' Demonstrate motivation and innovation for self-improvement. SCOPE INFORMATION Item Measure ' # Direct Reports ' # Indirect Reports ' Budgetary $ Responsibility PHYSICAL REQUIREMENTS The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. ' Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices. ' Ability to communicate both in person and/or by telephone]]> http://www.amerigroup-jobs.com/job/Nashville-Quality-Business-Analyst-II-Job-TN-37201/892048/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Quality-Business-Analyst-II-Job-TN-37201/892048/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12054
# Positions: 1
Location: US-TN-Nashville
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 7/30/2010

More information about this job:

Overview:

JOB SUMMARY: The Account Executive (AE) is responsible for Provider Quality Incentive Program initiatives. Account Executive communicates, analyzes and formulates agreement with Claims, Clinical Informatics, Compliance, Finance, Health Plan Healthcare Management Services and Provider Relations, Medical Economics, and Quality Management to reward our large-panel primary care providers and groups who meet quality benchmarks and improvement targets, as well as medical cost management targets. Program quality indicators have been selected based on an analysis of the greatest quality improvement opportunities for our members, and will be measured in a HEDIS-like fashion.

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Conducts market analysis to define large-panel primary care providers and groups who meet quality benchmarks and improvement targets, as well as meets criteria for medical cost management. 2. Assesses and analyzes quality and medical cost data results and manages the Provider Quality Incentive Program (PQIP) on behalf of local health plan. Stays abreast of program development and provides an ongoing objective evaluation of important aspects of data findings to report potential issues or concerns to upper management. 3. Works collaboratively with appropriate staff at various stages in the process. Functional areas are: Claims, Clinical Informatics, Compliance, Finance, Health Plan Healthcare Management Services and Provider Relations, Medical Economics, and Quality Management to analyze data. Make determination for next steps. 4. Educates and trains AGP staff, participating provider & staff, and associated AMERIGROUP leadership on their responsibilities in carrying out the quality improvement program. Chair functional area meetings to review analysis while maintaining Program integrity and in preparation for presentations to Committee. 5. Collects, analyzes and summarizes performance data, identifying opportunities for improvement and present finding to QPIP Committee. 6. Conducts meeting(s) with large-panel primary care providers and groups before and after they enter the QPIP Program. Monitor quality data and improvement targets as well as medical cost management targets. Review detailed analysis with provider to promote improvement in quality and management of service delivery. 7. Reviews new or modified program enhancements to determine if proposed processes are and/or will continue performing according to program specifications; if results potential yield a negative impact, conform by changing aspects where necessary. Recommends program improvements or corrections QPIP Committee. 8. Works with Providers to understand issues/concerns. Identifies root cause of problems and trends and participates in developing solutions. Works with Provider's staff and AMERIGROUP staff (local and/or corporate) to resolve the issue and monitor recurrence. 9. Assist with training and mentoring of the Provider Relations Representatives as needed to ensure departmental success and effective team work. In the absence of management, acts as the lead or senior associate in the department or for the assigned team. 10. Track and respond to in-person, telephonic, and written inquiries from providers and document all contacts in appropriate system per Plan (i.e. Sales force). 11. Performs other duties and special projects as assigned.

Qualifications:

EDUCATION AND EXPERIENCE: Education Required: Bachelor's degree in Business Administration & Management, Healthcare Administration and Management, or Nursing Preferred: Certified Medical Office Manager (CMOM), Quality Improvement Analyst/Mgr. Years and Type of Experience Required: Required: Minimum 5 years experience of practice manager, business analyst, claims manager, healthcare business office manager or outpatient clinic administrator Preferred: 3 years as a member of Practice Management Institute Specific Technical Skills Required: ' Ability to cultivate and maintain positive internal and external relationships ' Ability to work independently ' Ability to analyze and interpret statistical data ' Ability to effectively communicate statistical and qualitative interpretations in a non-offensive manner to medical professionals and staff ' Ability to guide the provider to better performance ' Experienced in CPT and ICD-9 Coding ' Experienced in running reports and developing presentations ' Excellent verbal and written communications skills ' Effective management skills ' organization, planning, setting goals and objectives, time management ' Effective leadership skills ' Excellent interpersonal skills ' Excellent social skills ' Thorough appreciation of cultural diversity and sensitivity toward target populations Certifications or Licensure Required: Preferred: CMOM, Certified Medical Coder (CMC), Registered Nurse or Licensed Practical Nurse Other Required: Preferred: SCOPE INFORMATION Item Measure ' # Direct Reports ' # Indirect Reports ' Budgetary $ Responsibility PHYSICAL REQUIREMENTS ' Must be able to operate a computer ' Must be able to operate a telephone ' Must be able to conduct and participate in meetings ' Must be able to travel on common carriers and adhere to AMERIGROUP's travel policies]]> http://www.amerigroup-jobs.com/job/Nashville-Provider-Account-Executive-Job-TN-37201/892049/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Provider-Account-Executive-Job-TN-37201/892049/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12056
# Positions: 1
Location: US-TN-Nashville
Search Category: Nursing
Type: Regular Full-Time (30+ hours)
Posted Date: 7/30/2010

More information about this job:

Overview:

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

Responsibilities:

PRIMARY RESPONSIBILITIES: 1. Obtains an accurate member history. 2. Assesses clinical information to develop care plans including a member support system. 3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements. 4. Establishes working relationships with referral sources and community resources. 5. Communicates care objectives to appropriate individuals/departments/referral sources. 6. Assessment of biopsychosocial factors. 7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team. 8. Collaborates with the member's PCP and specialists in the development of the plan of care to ensure that members' physical needs are addressed 9. Provide case management and/or disease management services to members, as identified by the health plan's CI3 list 10. May be required to conduct field visits. 11. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan 12. Acts as an advocate for an individual's health care needs. 13. Reviews benefit systems and cost benefit analysis. 14. Evaluates the quality of necessary medical services. 15. Utilizes criteria for authorizing appropriate clinical services. 16. Identifies members that would benefit from an alternative level of care. 17. Acquires data and evaluates necessary health services for cost containment. 18. Documents effectiveness of case management services. 19. Identifies the need for assistive devices/adaptive equipment needed for members. 20. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation. 21. Requests direction from appropriate supervisor(s) on complex issues. 22. Utilizes leadership skills for non-clinical team members. 23. Collaboratively works with other departments. 24. Participates in Quality Improvement processes. 25. Serves on internal and external committees. 26. Maintains member confidentiality. 27. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE: Education Required: ' Current RN state license required. Preferred: ' Bachelors or Masters Degree. Years and Type of Experience Required: Required: ' Four years experience in health care, case management, discharge planning or behavioral health. Preferred: ' Experience working on the community level and with community agencies preferred. Specific Technical Skills Required: Preferred: Certifications or Licensure Required: ' Must possess a valid driver's license and access to a motor vehicle. Preferred: ' Certified case managers preferred. Other Required: ' Computer literate. ' Excellent verbal and written communications skills. ' Strong decision making skills. ' Ability to provide services in an environment that involves multiple health care systems. ' Ability to interact with all relevant components of the health care system. ' Ability to provide services that deal with the individual's broad spectrum of needs. ' Self-starter with ability to handle multiple projects at one time. ' Appreciation of cultural diversity and sensitivity towards target population. ' Bilingual a plus. Preferred: PHYSICAL REQUIREMENTS: ' Must be able to operate a computer. ' Must be able to operate (and communicate via) a telephone. ' Must be able to sit for long periods of tim]]> http://www.amerigroup-jobs.com/job/Nashville-Case-Manager-RN-Plan-Job-TN-37201/892051/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Case-Manager-RN-Plan-Job-TN-37201/892051/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12044
# Positions: 1
Location: US-TN-Nashville
Search Category: Nursing
Type: Regular Full-Time (30+ hours)
Posted Date: 7/29/2010

More information about this job:

Overview:

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

Responsibilities:

1. Obtains an accurate member history.

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

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

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

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

6. Assessment of biopsychosocial factors.

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

8. May be required to conduct field visits.

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

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

11. Reviews benefit systems and cost benefit analysis.

12. Evaluates the quality of necessary medical services.

13. Utilizes criteria for authorizing appropriate clinical services.

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

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

16. Documents effectiveness of case management services.

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

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

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

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

21. Collaboratively works with other departments.

22. Participates in Quality Improvement processes.

23. Serves on internal and external committees.

24. Maintains member confidentiality.

25. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required: LVN, LPN, LPC, LSW, or LMHC (CMSW for TN Plan) required with four years experience in health care, case management, discharge planning or behavioral health.

Preferred: Bachelors or Masters Degree and three years experience in health care, case management, discharge planning, or behavioral health.

Years and Type of Experience Required:

Required:

Current State license to practice Nursing, Social Work or Behavioral Health, or Counseling, (or) TN Plan Only: current state CMSW certificate

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

Certifications or Licensure

Required:

- Certified case managers preferred.
- Must possess a valid driver's license and access to a motor vehicle.

Other

Required:

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

PHYSICAL REQUIREMENTS:

- Must be able to operate a computer.
- Must be able to operate (and communicate via) a telephone.
- Must be able to sit for long periods of tim]]> http://www.amerigroup-jobs.com/job/Nashville-Care-Coordinator-Long-Term-Care-Davidson,-Dickson,-Montgomery-Counties-Job-TN-37201/890940/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Nashville-Care-Coordinator-Long-Term-Care-Davidson,-Dickson,-Montgomery-Counties-Job-TN-37201/890940/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS