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		<title>Amerigroup - New York City Behavioral Health Jobs</title>
		<link>http://www.amerigroup-jobs.com/go/New-York-City-Behavioral-Health-Jobs/168987/</link>
		<description>View New York City Behavioral Health Jobs at Amerigroup</description>
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			<title><![CDATA[Amerigroup - New York City Behavioral Health Jobs]]></title>
			<link>http://www.amerigroup-jobs.com/go/New-York-City-Behavioral-Health-Jobs/168987/</link>
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		<title>Enrollment Nurse-Korean Speaking Preferred (New York, NY, US)</title>
		<description><![CDATA[Enrollment Nurse-Korean Speaking Preferred<br/><br/><b>Job ID:</b>  2010-12062 <br/><b># Positions:</b>  1<br/><b>Location:</b>  US-NY-New York <br/><b>Search Category:</b>  Nursing<br/><b>Type:</b>  Regular Full-Time (30+ hours) <br/><b>Posted Date:</b>  8/2/2010<br/><br/>More information about this job:<br/><br/><b>Overview:</b><br/><br/><b>JOB SUMMARY</b>: 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.<br/><br/><b><b>Responsibilities:</b></b><br/><br/><b>PRIMARY RESPONSIBILITIES</b>: 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.<br/><br/>Qualifications:<br/><br/><b>EDUCATION AND EXPERIENCE</b>: <b>Education <b>Required:</b></b> ' Current RN state license required. Preferred: ' Bachelors or Masters Degree. <b><b>Years and Type of Experience <b>Required:</b></b> <b>Required:</b></b> ' 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. <b>Specific Technical Skills <b>Required:</b></b> Preferred: <b>Certifications or Licensure <b>Required:</b></b> ' Must possess a valid driver's license and access to a motor vehicle. Preferred: ' Certified case managers preferred. <b>Other <b>Required:</b></b> ' 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: <b>PHYSICAL REQUIREMENTS</b>: ' 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]]></description>
		<pubDate></pubDate>		<link>http://www.amerigroup-jobs.com/job/New-York-Enrollment-Nurse-Korean-Speaking-Preferred-Job-NY-10001/893091/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</link>
		<guid>http://www.amerigroup-jobs.com/job/New-York-Enrollment-Nurse-Korean-Speaking-Preferred-Job-NY-10001/893091/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</guid>
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		<title>Contracting Account Rep- Plan (New York, NY, US)</title>
		<description><![CDATA[Contracting Account Rep- Plan<br/><br/><b>Job ID:</b>  2010-12278 <br/><b># Positions:</b>  1<br/><b>Location:</b>  US-NY-New York <br/><b>Search Category:</b>  Health Care Operations<br/><b>Type:</b>  Regular Full-Time (30+ hours) <br/><b>Posted Date:</b>  8/31/2010<br/><br/>More information about this job:<br/><br/><b>Overview:</b><br/><br/><b>JOB SUMMARY</b>:  Responsible for identifying, and recruiting new providers as well as ancillary providers into the network and maintaining collaborative and positive relationships with these providers. Manages provider and/or ancillary and behavioral health networks including contracting, negotiating, training, retention, monitoring, and support. Provide account management services to select hospitals within the AMERIGROUP network, including issue resolution, claims investigations, and provider education. Additional activities such as claim resolution and completing Provider Access Study Reports as appropriate.<br/><br/><b><b>Responsibilities:</b></b><br/><br/><b>PRIMARY RESPONSIBILITIES</b>:<br/><br/>1.       Supports medical management on identification of appropriate providers to meet member?s medical needs, primarily with non-participating providers.<br/><br/>2.      Negotiates reimbursement rates with non-participating providers.<br/><br/>3.      Collect necessary provider information including liability and licensure<br/><br/>4.      Renegotiate contract when there is a change in Company policy or Provider requests changes<br/><br/>5.      Assists providers with claims issues and projects.  Investigates and attempts to identify root cause of issues.<br/><br/>6.      Participates in problem solving with providers. Provider feedback to other departments on problems encountered.  Identifies trends and recommends remedial actions.<br/><br/>7.      Participates in provider access studies and creates provider access study reports.<br/><br/>8.      Assure that all providers understand the Plan?s policies, procedures, and contractual obligations<br/><br/>9.      Build a partnership with each of the Plan?s providers and office staff<br/><br/>10.   Keep provider files current with appropriate documentation and correspondence<br/><br/>11.    Follows up on provider complaints received from the State.<br/><br/>12.   Creates and maintains all information required to support the network development process.<br/><br/>13.   Other duties as requested and assigned.<br/><br/>Network Development (as required by Plan needs)<br/><br/>1.    Analyze ancillary provider network for adequacy in addressing members? medical needs<br/><br/>2.    Identify and recruit key ancillary providers to address gaps in provider network<br/><br/>3.    Negotiate specified ancillary contracts<br/><br/>4.   Collaborate with local and corporate staff  as necessary to ensure that appropriate contracts are<br/><br/>executed and implemented and that all ancillary providers are credentialed in a timely manner in<br/><br/>accordance with standards and guidelines<br/><br/>5.    Manage ongoing relationships with providers<br/><br/>6.    Coordinates and participates in major network expansion projects as assigned<br/><br/>7.    Implements provider satisfaction initiatives as determined by the company?s strategic goals<br/><br/>Hospital Services contracting  (as required by Plan needs)<br/><br/>1.          Track and manage claims issues through regular interaction with key hospital personnel<br/><br/>2.         Identify, investigate, and resolve root cause problems to reduce the number of billing complaints/appeals<br/><br/>3.         Provide education and orientations with hospital staff on a regular basis (or as needed) regarding AMERIGROUP policies and procedures, authorizations, Quick Reference Guides, etc.<br/><br/>4.         Collaborate with the Director, Contracting to identify possible billing inefficiencies or issues<br/><br/>5.         Ensure hospital staff is accessing AMERIGROUP?s IVR and Internet-based functions while promoting electronic billing<br/><br/>Single Case Agrrement Contracting (as required by Plan needs)<br/><br/>1.     Identifies non-participating providers who are willing to establish Single Case Agreements.<br/><br/>2   Creates Single Case Agreements and follows up with the provider?s office to achieve the     provider?s signature.<br/><br/>Qualifications:<br/><br/><b>EDUCATION AND EXPERIENCE</b>:<br/><br/><b>Required:</b><br/><br/>- High School diploma or equivalent<br/><br/>Preferred:<br/><br/>- Bachelors Degree; experience substitutes for degree<br/><br/>Experience<br/><br/><b>Required:</b><br/><br/>- 2 years experience in provider contracting and/or provider relations<br/><br/>Preferred:<br/><br/>- 3-5 years managed care experience<br/><br/>Specific Technical Skills<br/><br/><b>Required:</b><br/><br/>- Proficient in Microsoft Word and Microsoft Excel<br/><br/>Preferred:<br/><br/>Certifications or Licensures<br/><br/><b>Required:</b><br/><br/>- Must have valid driver?s license and access to a motor vehicle<br/><br/>Preferred:<br/><br/>- <br/><b>Other:</b><br/><br/><b>Required:</b><br/><br/>- Claims experience<br/>- Knowledge of medical coding.<br/>- Excellent organizational skills and ability to meet deadlines.<br/>- Excellent verbal and written communication skills.<br/>- Above average negotiation skills<br/>- Excellent presentation skills<br/>- Ability to maintain a calm and professional demeanor in difficult and frustrating situations.<br/>- Appreciation of cultural diversity and sensitivity towards target population.<br/><br/>Preferred:<br/><br/>SCOPE INFORMATION<br/><br/># Direct Reports:<br/><br/># Indirect Reports:<br/><br/>Budgetary $ Responsibility:<br/><br/><b>PHYSICAL REQUIREMENTS</b><br/><br/>- Must be able to operate a computer.<br/><br/>- Must be able to operate a telephone.<br/>- Must be able to travel locally to providers? offices]]></description>
		<pubDate></pubDate>		<link>http://www.amerigroup-jobs.com/job/New-York-Contracting-Account-Rep-Plan-NY-10001/923044/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</link>
		<guid>http://www.amerigroup-jobs.com/job/New-York-Contracting-Account-Rep-Plan-NY-10001/923044/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</guid>
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		<title>Bilingual Spanish Speaking Enrollment Nurse (New York, NY, US)</title>
		<description><![CDATA[Bilingual Spanish Speaking Enrollment Nurse<br/><br/><b>Job ID:</b>  2010-12033 <br/><b># Positions:</b>  1<br/><b>Location:</b>  US-NY-New York <br/><b>Search Category:</b>  Nursing<br/><b>Type:</b>  Regular Full-Time (30+ hours) <br/><b>Posted Date:</b>  7/28/2010<br/><br/>More information about this job:<br/><br/><b>Overview:</b><br/><br/><b>JOB SUMMARY</b>: The Enrollment Nurse 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.<br/><br/><b><b>Responsibilities:</b></b><br/><br/><b>PRIMARY RESPONSIBILITIES</b>: 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.<br/><br/>Qualifications:<br/><br/><b>EDUCATION AND EXPERIENCE</b>: <b>Education <b>Required:</b></b> ' Current RN state license required. Preferred: ' Bachelors or Masters Degree. <b><b>Years and Type of Experience <b>Required:</b></b> <b>Required:</b></b> ' 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. <b>Specific Technical Skills <b>Required:</b></b> Preferred: <b>Certifications or Licensure <b>Required:</b></b> ' Must possess a valid driver's license and access to a motor vehicle. Preferred: ' Certified case managers preferred. <b>Other <b>Required:</b></b> ' 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: <b>PHYSICAL REQUIREMENTS</b>: ' 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]]></description>
		<pubDate></pubDate>		<link>http://www.amerigroup-jobs.com/job/New-York-Bilingual-Spanish-Speaking-Enrollment-Nurse-Job-NY-10001/889745/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</link>
		<guid>http://www.amerigroup-jobs.com/job/New-York-Bilingual-Spanish-Speaking-Enrollment-Nurse-Job-NY-10001/889745/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</guid>
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		<title>Case Manager RN - Plan (New York, NY, US)</title>
		<description><![CDATA[Case Manager RN - Plan<br/><br/><b>Job ID:</b>  2010-12235 <br/><b># Positions:</b>  1<br/><b>Location:</b>  US-NY-New York <br/><b>Search Category:</b>  Nursing<br/><b>Type:</b>  Regular Full-Time (30+ hours) <br/><b>Posted Date:</b>  8/25/2010<br/><br/>More information about this job:<br/><br/><b>Overview:</b><br/><br/><b>JOB SUMMARY</b>: 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.<br/><br/><b><b>Responsibilities:</b></b><br/><br/><b>PRIMARY RESPONSIBILITIES</b>: 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.<br/><br/>Qualifications:<br/><br/><b>EDUCATION AND EXPERIENCE</b>: <b>Education <b>Required:</b></b> ' Current RN state license required. Preferred: ' Bachelors or Masters Degree. <b><b>Years and Type of Experience <b>Required:</b></b> <b>Required:</b></b> ' 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. <b>Specific Technical Skills <b>Required:</b></b> Preferred: <b>Certifications or Licensure <b>Required:</b></b> ' Must possess a valid driver's license and access to a motor vehicle. Preferred: ' Certified case managers preferred. <b>Other <b>Required:</b></b> ' 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: <b>PHYSICAL REQUIREMENTS</b>: ' 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]]></description>
		<pubDate></pubDate>		<link>http://www.amerigroup-jobs.com/job/New-York-Case-Manager-RN-Plan-NY-10001/917397/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</link>
		<guid>http://www.amerigroup-jobs.com/job/New-York-Case-Manager-RN-Plan-NY-10001/917397/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</guid>
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		<title>Director of Utilization Management (New York, NY, US)</title>
		<description><![CDATA[Director of Utilization Management<br/><br/><b>Job ID:</b>  2010-11664 <br/><b># Positions:</b>  1<br/><b>Location:</b>  US-NY-New York <br/><b>Search Category:</b>  Nursing<br/><b>Type:</b>  Regular Full-Time (30+ hours) <br/><b>Posted Date:</b>  7/23/2010<br/><br/>More information about this job:<br/><br/><b>Overview:</b><br/><br/>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.<br/><br/><b><b>Responsibilities:</b></b><br/><br/>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.<br/><br/>2. Manages and evaluates team performance and ensure adherence to department standards<br/><br/>3. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.<br/><br/>4. Works with providers to establish short and long term goals that meet the members need, functional abilities and referral sources requirements.<br/><br/>5. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.<br/><br/>6. Coordinates the identifications of members with potential for high risk complications.<br/><br/>7. Assesses members present level of physical/mental impairment utilizing defined criteria and methodology.<br/><br/>8. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.<br/><br/>9. Review benefit systems and cost benefit analysis.<br/><br/>10. Evaluates the member against level of care criteria.<br/><br/>11. Demonstrates knowledge of utilization management targets.<br/><br/>12. Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.<br/><br/>13. Requests direction from Medical Director on complex healthcare issues.<br/><br/>14. Maintains member confidentiality and respect of the patient bill of rights.<br/><br/>15. Other duties as assigned.<br/><br/>Qualifications:<br/><br/><b>EDUCATION AND EXPERIENCE</b>:<br/><br/>Education<br/><br/><b>Required:</b><br/><br/>- Bachelors Degree, or equivalent work experience<br/><br/>Preferred:<br/><br/>- MSN, MPH, MPA, or MSW or related or MBA with Health Care Concentration<br/><br/><b>Years and Type of Experience <b>Required:</b></b><br/><br/><b>Required:</b><br/><br/>- Five years experience in health Care Management and at least one year of leadership/management experience.<br/><br/><b>Knowledge and Technical Skills <b>Required:</b></b><br/><br/>- Knowledge of community resources<br/>- Basic Computer skills to include Microsoft Word and Excel<br/>- Ability to provide supervision to multidisciplinary team<br/>- Strong decision making skills<br/>- Ability to provide services in an environment that involves multiple health, mental health and substance abuse care systems.<br/>- Ability to interact with all relevant components of the health and behavioral health care systems<br/>- Self starter with the ability to handle multiple projects at one time.<br/><br/>Certifications or Licensure<br/><br/><b>Required:</b><br/><br/>- RN, or PA, or LSW, or LPC, or LMHC<br/><br/>Preferred:<br/><br/>- Certified Case Manager<br/><br/>SCOPE INFORMATION Item Measure<br/><br/>- # Direct Reports 2-10 (or individual contributor in a coaching/training capacity within the department)<br/>- Budgetary $ Responsibility none<br/><br/><b>PHYSICAL REQUIREMENTS</b><br/><br/>- Able to operate a computer<br/>- Able to operate a telephone]]></description>
		<pubDate></pubDate>		<link>http://www.amerigroup-jobs.com/job/New-York-Manager-Director-of-Health-Care-Mgmt-Services-Job-NY-10001/886498/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</link>
		<guid>http://www.amerigroup-jobs.com/job/New-York-Manager-Director-of-Health-Care-Mgmt-Services-Job-NY-10001/886498/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</guid>
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		<title>Utilization Case Manager, RN (New York, NY, US)</title>
		<description><![CDATA[Utilization Case Manager, RN<br/><br/><b>Job ID:</b>  2010-11666 <br/><b># Positions:</b>  1<br/><b>Location:</b>  US-NY-New York <br/><b>Search Category:</b>  Nursing<br/><b>Type:</b>  Regular Full-Time (30+ hours) <br/><b>Posted Date:</b>  7/23/2010<br/><br/>More information about this job:<br/><br/><b>Overview:</b><br/><br/>The Utilization 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 members health care needs without compromising quality of outcomes.<br/><br/><b><b>Responsibilities:</b></b><br/><br/>1. Obtains an accurate member history.<br/><br/>2. Assesses clinical information to develop care plans including a member support system.<br/><br/>3. Establishes short and long term goals in collaboration with the member that meet the members needs and the referral sources requirements.<br/><br/>4. Establishes working relationships with referral sources and community resources.<br/><br/>5. Communicates care objectives to appropriate individuals/departments/referral sources.<br/><br/>6. Assessment of biopsychosocial factors.<br/><br/>7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.<br/><br/>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<br/><br/>9. Provide case management and/or disease management services to members, as identified by the health plan's CI3 list<br/><br/>10. May be required to conduct field visits.<br/><br/>11. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan<br/><br/>12. Acts as an advocate for an individual's health care needs.<br/><br/>13. Reviews benefit systems and cost benefit analysis.<br/><br/>14. Evaluates the quality of necessary medical services.<br/><br/>15. Utilizes criteria for authorizing appropriate clinical services.<br/><br/>16. Identifies members that would benefit from an alternative level of care.<br/><br/>17. Acquires data and evaluates necessary health services for cost containment.<br/><br/>18. Documents effectiveness of case management services.<br/><br/>19. Identifies the need for assistive devices/adaptive equipment needed for members.<br/><br/>20. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.<br/><br/>21. Requests direction from appropriate supervisor(s) on complex issues.<br/><br/>22. Utilizes leadership skills for non-clinical team members.<br/><br/>23. Collaboratively works with other departments.<br/><br/>24. Participates in Quality Improvement processes.<br/><br/>25. Serves on internal and external committees.<br/><br/>26. Maintains member confidentiality.<br/><br/>27. Other duties as requested or assigned.<br/><br/>Qualifications:<br/><br/><b>EDUCATION AND EXPERIENCE</b>:<br/><br/>Education<br/><br/><b>Required:</b><br/><br/>- Current RN state license required.<br/><br/>Preferred:<br/><br/>- Bachelors or Masters Degree.<br/><br/><b>Years and Type of Experience <b>Required:</b></b><br/><br/><b>Required:</b><br/><br/>- Four years experience in health care, case management, discharge planning or behavioral health.<br/><br/>Preferred:<br/><br/>- Experience working on the comCmunity level and with community agencies preferred.<br/><br/>Certifications or Licensure<br/><br/><b>Required:</b><br/><br/>- Must possess a valid drivers license and access to a motor vehicle.<br/><br/>Preferred:<br/><br/>- Certified case managers preferred.<br/><br/>Other<br/><br/><b>Required:</b><br/><br/>- Computer literate.<br/>- Excellent verbal and written communications skills.<br/>- Strong decision making skills.<br/>- Ability to provide services in an environment that involves multiple health care systems.<br/>- Ability to interact with all relevant components of the health care system.<br/>- Ability to provide services that deal with the individuals broad spectrum of needs.<br/>- Self-starter with ability to handle multiple projects at one time.<br/>- Appreciation of cultural diversity and sensitivity towards target population.<br/>- Bilingual a plus.<br/><br/><b>PHYSICAL REQUIREMENTS</b>:<br/><br/>- Must be able to operate a computer.<br/>- Must be able to operate (and communicate via) a telephone.<br/>- Must be able to sit for long periods of time]]></description>
		<pubDate></pubDate>		<link>http://www.amerigroup-jobs.com/job/New-York-Utilization-Case-Manager,-RN-Job-NY-10001/886499/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</link>
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		<title>Bilingual Spanish Speaking Case Manager RN (New York, NY, US)</title>
		<description><![CDATA[Bilingual Spanish Speaking Case Manager RN<br/><br/><b>Job ID:</b>  2010-12201 <br/><b># Positions:</b>  1<br/><b>Location:</b>  US-NY-New York <br/><b>Search Category:</b>  Nursing<br/><b>Type:</b>  Regular Full-Time (30+ hours) <br/><b>Posted Date:</b>  8/20/2010<br/><br/>More information about this job:<br/><br/><b>Overview:</b><br/><br/><b>JOB SUMMARY</b>: 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.<br/><br/><b><b>Responsibilities:</b></b><br/><br/><b>PRIMARY RESPONSIBILITIES</b>: 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.<br/><br/>Qualifications:<br/><br/><b>EDUCATION AND EXPERIENCE</b>: <b>Education <b>Required:</b></b> ' Current RN state license required. Preferred: ' Bachelors or Masters Degree. <b><b>Years and Type of Experience <b>Required:</b></b> <b>Required:</b></b> ' 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. <b>Specific Technical Skills <b>Required:</b></b> Preferred: <b>Certifications or Licensure <b>Required:</b></b> ' Must possess a valid driver's license and access to a motor vehicle. Preferred: ' Certified case managers preferred. <b>Other <b>Required:</b></b> ' 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: <b>PHYSICAL REQUIREMENTS</b>: ' 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]]></description>
		<pubDate></pubDate>		<link>http://www.amerigroup-jobs.com/job/New-York-Bilingual-Spanish-Speaking-Case-Manager-RN-NY-10001/914225/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</link>
		<guid>http://www.amerigroup-jobs.com/job/New-York-Bilingual-Spanish-Speaking-Case-Manager-RN-NY-10001/914225/?utm_source=J2WRSS&amp;utm_medium=rss&amp;utm_campaign=J2W%5FRSS</guid>
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