http://www.amerigroup-jobs.com/go/Fort-Worth-Customer-Service-Jobs/169135/ View Fort Worth Customer Service Jobs at Amerigroup Wed, 08 Sep 2010 02:09:36 GMT en-us /sites/amerigroup/images/banner.gif http://www.amerigroup-jobs.com/go/Fort-Worth-Customer-Service-Jobs/169135/ 720
Job ID: 2010-12200
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/19/2010

More information about this job:

Overview:

JOB SUMMARY:

Builds and supports our Medicare provider network.

Serves as liaison to providers (including physicians, hospitals, and/or ancillary providers) and internal departments at the health plan. Responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers for Medicare product.

These activities include responding to inquiries from providers regarding benefits, claim resolution, appeal status, and authorization or referral information. Also may be responsible for recruiting providers to ensure network access and service adequacy.

Responsibilities:

PRIMARY RESPONSIBILITIES:

1. Source and contract with Medicare providers.
2. 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).
3. Ensures that provider relationships with the Plan are positive and productive for both parties.
4. 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.
5. Collaborates with local and corporate staff as necessary to ensure that appropriate applications are processed, contracts are executed and all providers are credentialed in a timely manner.
6. Analyzes provider network for adequacy in addressing members' medical needs and assists in the identification and recruitment of key providers where network gaps or needs exist.
7. Creates and maintains information required to support the network development process.
8. Develops training materials and conducts on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures.
9. Provides expertise and assistance relative to provider billing and payment guidelines consistent with AMERIGROUP policies and procedures.
10. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled within established time frames.
11. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.
12. Performs other duties and special projects as assigned

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:

- BA/BS degree or equivalent experience

Years and Type of Experience Required:

Required:

- 5+ years of managed care experience, preferably in a Medicaid or Medicare environment

- Minimum 3+ years Provider Service experience working with Medicare providers

- Minimum 2 years network development and/or provider contracting

Specific Technical Skills

Required:

- Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
- Claims experience/knowledge of medical coding
- Strong telephonic and customer service skills.
- Effective presentation skills.

Preferred:

- Experience using Sales force CRM
- Experience using Facets.

Certifications or Licensures

Required:

- Valid Drivers License and Auto Insurance

Other:

Required:

- Excellent verbal and written communication skills
- Strong negotiation skills
- Detail-oriented
- Ability to handle multiple tasks in a fast-paced environment
- Must be service oriented and able to identify and resolve problems
- Appreciation of cultural diversity and sensitivity toward target population

PHYSICAL REQUIREMENTS

- Must be able to operate a computer, telephone and fax machine
- Must be able to travel locally
- Must be able to operate a motor vehicle
- Must be able to conduct and participate in meetings]]> http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-TX-75050/914224/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-TX-75050/914224/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12158
# Positions: 3
Location: US-TX-Grand Prairie
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 8/19/2010

More information about this job:

Overview:

JOB SUMMARY: The Case Specialist - Plan is responsible for managing care and services to members. Case Specialists works in conjunction with Case Managers to coordinate health care services by facilitating, scheduling, and arranging a variety of treatment and health care plans.

Responsibilities:

1. Coordination, authorization, fulfillment, monitoring and tracking of health care services.

2. Establish working relationships with referral sources

3. Initiates and maintains contact with assigned individuals/significant others and providers to determine members response to services.

4. Coordinate home visits for Case Managers.

5. Review of benefit systems.

6. Identifies cases in consultation with Case Manager that would benefit from alternative care.

7. Coordinates assignments for Case Managers to facilitate timely member evaluation.

8. Arranges for services as identified by the case manager such as home health resources, alternative long-term care placements etc.

9. Knowledge of care-coordination and case management concepts.

10. Identifies potential liability issues for services provided.

11. Utilizes knowledge of community resources.

12. Refers members to case management as indicated.

13. Ensures that health care services are received as authorized by the provider.

14. Collaboratively works with other departments.

15. Utilizes excellent customer service principles to assist internal and external customers.

16. Maintains member confidentiality.

17. Other duties as requested or assigned.

Qualifications:

Education Required:

Associate Degree required (or equivalent experience)

Preferred:

' Bachelors degree preferred

' Medical Terminology preferred

Years and Type of Experience Required: Required:

' Minimum of (2) years working in Health Services field

' Bilingual an asset.

Other Required:

' Computer literate

' Excellent verbal and written communication 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 individuals broad spectrum of needs

' High energy level.

' 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 a telephone]]> http://www.amerigroup-jobs.com/job/Grand-Prairie-Case-Specialist-(OCC)-TX-75050/912467/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Case-Specialist-(OCC)-TX-75050/912467/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12192
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Administrative Services
Type: Regular Full-Time (30+ hours)
Posted Date: 8/19/2010

More information about this job:

Overview:

The Denials and Appeals Coordinator is responsible for the coordination of the Medical Denials and Appeals process, interfacing with HCMS and/or Quality Management Leadership for appeals. The Denials and Appeals Coordinator is responsible for tracking, trending, and reporting all denials / appeals and for assuring that all regulatory, state, and contractual requirements are met.

Responsibilities:

1. Assist in writing, tracking and sending out denial letters according to Grier Consent Decree.
2.
Coordinates, tracks, trends and reports all Medical denials and/or appeals.

3.
Functions as a liaison between the Plan, Dedicated Service Center Representatives, State agency contacts and Providers regarding medical denials and appeals.

4.
Forwards member payment appeal issues to the Claims Department for assistance in resolving complex claim denial and appeal issues.

5.
Ensures compliance with state and regulatory mandated time lines for medical denials and appeals.

6.
Assures all documentation is accurate and completed timely per regulatory mandated times.

7.
Assists with the development of training and resource materials related to the medical denial and appeal process in compliance with regulatory mandates.

8.
Utilizes excellent customer service principles to assist internal and external customers.

9.
Utilizes effective communication, conflict management and negotiation skills

10.
Identifies and reports any quality or utilization issues to the appropriate individual in management

11.
Ensures ongoing communication with service providers.

12.
Collaboratively works with other departments

13.
Creatively explores alternatives in the appeals process.

14.
Applies problem-solving techniques to the appeal/denial process.

15.
Other duties as assigned.

Qualifications:

Education Required:

- HS Graduate

Years and Type of Experience Required: Required:

- 2 years previous experience in claims / denial / appeal process
- Experience with computer software, including data management programs preferred

- Knowledgeable of Medicaid, Medicare, state guidelines and regulations

Other Required:

- Demonstrates out-going, positive attitude toward problem resolution for internal and external customers
- Detail-oriented
- Excellent verbal and written communication skills
- Demonstrates leadership capability
- Self-disciplined, self starter and self-motivated
- Ability to prioritize
- Computer literate
- Ability to interface with providers, members and state agencies about the denial and appeal process
- Appreciation of cultural diversity and sensitivity towards target population

PHYSICAL REQUIREMENTS:

- Must be able to operate a computer
- Must be able to operate a telephone
- Eyesight to accommodate large volumes of reading
- Clear speech for public speaking
- Good hearing for effective communication]]> http://www.amerigroup-jobs.com/job/Grand-Prairie-Coordinator,-Denials-&-Appeals-TX-75050/912475/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Coordinator,-Denials-&-Appeals-TX-75050/912475/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12198
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Nursing
Type: Regular Full-Time (30+ hours)
Posted Date: 8/19/2010

More information about this job:

Overview:

Performs technical and administrative work required to evaluate the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Licensed RN responsible for clinical review of all acute and subacute services for appropriateness based on medical criteria. This individual is responsible for the management of healthcare resources necessary and appropriate for achievement of desired acute and subacute outcomes and the coordination of alternative levels of care for membership.

Responsibilities:

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

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

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

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

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

6. Strives to maintain quality care while effectively utilizing resources.

7. Identifies and reports any quality or utilization issues to the Medical Director.

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

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

10. Participates in rounds with the Medical Director.

11. Review Plan appeal items for concurrent and retrospective reviews as required and requested.

12. Monitors and facilities appropriate utilization of resources utilizing clinical criteria.

13. Tracks and reports trends of inappropriate utilization of resources to the Medical Director.

14. Participates in a multi-disciplinary clinical team to achieve positive member outcomes.

15. Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

16. Utilizes effective communication, conflict management and negotiation skills.

17. Utilizes excellent customer service principles to assist internal and external customers.

18. Participates in Quality Improvement Process.

19. Maintains member confidentiality.

20. Other duties as requested or assigned.

Qualifications:

Years and Type of Experience Required: Required:

- Two years of Utilization Management or Hospital/Acute care experience required.
- Currently licensed RN with three years experience in health care, case management, discharge planning, utilization management, or behavioral health.
- Experience working on the community level and with community agencies preferred.

Certifications or Licensure Required:

- Current State RN license
- Certified Professional Utilization Review (as required by Plan)
- Certified Case Managers a plus.
- 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 a telephone.
- Must be able to sit for long periods of time.
- Must be able to operate a motor vehicle and travel locally (as required by Plan)]]> http://www.amerigroup-jobs.com/job/Grand-Prairie-Utilization-Manager-RN-TX-75050/912480/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Utilization-Manager-RN-TX-75050/912480/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12145
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/13/2010

More information about this job:

Overview:

Serves as liaison to providers (including physicians, hospitals, and/or ancillary providers) and internal departments at the health plan. Responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers for Medicare product.

These activities include responding to inquiries from providers regarding benefits, claim resolution, appeal status, and authorization or referral information. Also may be responsible for recruiting providers to ensure network access and service adequacy.

Responsibilities:

PRIMARY RESPONSIBILITIES:

1. Source and contract with Medicare providers.
2. 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).
3. Ensures that provider relationships with the Plan are positive and productive for both parties.
4. 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.
5. Collaborates with local and corporate staff as necessary to ensure that appropriate applications are processed, contracts are executed and all providers are credentialed in a timely manner.
6. Creates and maintains information required to support the network development process.
7. Develops training materials and conducts on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures.
8. Provides expertise and assistance relative to provider billing and payment guidelines consistent with AMERIGROUP policies and procedures.
9. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled within established time frames.
10. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.
11. Performs other duties and special projects as assigned

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:

- BA/BS degree or equivalent experience

Years and Type of Experience Required:

Required:

- 5+ years of managed care experience, preferably in a Medicaid or Medicare environment
- Minimum 3+ years Provider Service experience working with Medicare providers
- Minimum 2 years network development and/or provider contracting

Specific Technical Skills

Required:

- Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
- Claims experience/knowledge of medical coding
- Strong telephonic and customer service skills.
- Effective presentation skills.

Preferred:

- Experience using Sales force CRM
- Experience using Facets.

Certifications or Licensures

Required:

- Valid Drivers License and Auto Insurance

Other:

Required:

- Excellent verbal and written communication skills
- Strong negotiation skills
- Detail-oriented
- Ability to handle multiple tasks in a fast-paced environment
- Must be service oriented and able to identify and resolve problems
- Appreciation of cultural diversity and sensitivity toward target population

PHYSICAL REQUIREMENTS

- Must be able to operate a computer, telephone and fax machine
- Must be able to travel locally
- Must be able to operate a motor vehicle
- Must be able to conduct and participate in meetings]]> http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-Job-TX-75050/908006/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-Job-TX-75050/908006/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12146
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Customer Service
Type: Regular Full-Time (30+ hours)
Posted Date: 8/13/2010

More information about this job:

Overview:

Serves as an Account Rep to hospitals, free standing facilities, and/or ancillary providers.

Responsible for performing activities designed to establish and maintain positive and productive relationships with Amerigroup network providers for Medicaid and Medicare products. These activities include responding to inquiries from providers regarding benefits, claim resolution, appeal status, and authorization or referral information.

Also responsible for recruiting providers to ensure network access and service adequacy. Will perform position requirements in the field or telephonically, as appropriate.

Responsibilities:

1. Source and contract with providers to ensure network adequacy.

2. 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).

3. Ensure that provider relationships with the Plan are positive and productive for both parties.

4. Work with Providers to understand issues/concerns. Identify root cause of problems and trends and participates in developing solutions. Work with Provider's staff and Amerigroup staff (local and/or corporate) to resolve the issue and monitor recurrence.

5. Collaborate with local and corporate staff as necessary to ensure that appropriate applications are processed, contracts are executed and all providers are credentialed in a timely manner.

6. Analyze provider network for adequacy in addressing members' medical needs and assist in the identification and recruitment of key providers where network gaps or needs exist.

7. Create and maintain information required to support the network development process.

8. Develop training materials and conduct on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with Amerigroup benefits, policies, and procedures.

9. Provide expertise and assistance relative to provider billing and payment guidelines consistent with Amerigroup policies and procedures.

10. Provide follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled within established time frames.

11. Participate in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.

12. Perform other duties and special projects as assigned

Qualifications:

Education

Required:

- BA/BS degree or equivalent experience

Years and Type of Experience Required:

Required:

- 5+ years of managed care experience, preferably in a Medicaid and/or Medicare environment

- 3+ years Network Development and/or Provider Contracting experience

Specific Technical Skills

Required:

- Strong negotiation skills

- Proficiency with Microsoft computer applications including Outlook, Word, and Excel

- Claims experience/knowledge of medical coding

- Strong telephonic and customer service skills

- Effective presentation skills

- Excellent verbal and written communication skills

- Detail-oriented

- Ability to handle multiple tasks in a fast-paced environment

- Must be service oriented and able to identify and resolve problems

- Appreciation of cultural diversity and sensitivity toward target population

Preferred:

- Experience using Sales force CRM

- Experience using Facets

Certifications or Licensures

Required:

- Valid Drivers License and Automobile insurance

PHYSICAL REQUIREMENTS

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

- Must be able to travel locally

- Must be able to operate a motor vehicle

- Must be able to conduct and participate in meetings]]> http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-Job-TX-75050/908007/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Provider-Relations-Rep-II-Job-TX-75050/908007/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12149
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Administrative Services
Type: Regular Full-Time (30+ hours)
Posted Date: 8/13/2010

More information about this job:

Overview:

Under general supervision, performs a variety of administration functions and provides administrative support to an executive and/or department. Relies on experience and judgment to plan and accomplish responsibilities.

Responsibilities:

1. Manages executive schedule and time.

2. Assists in meeting planning and preparation work, i.e., drafting agendas, minutes, and information on meetings. Seeks agenda items from other attendees.

3. Prepares draft documents/reports/correspondence for signature or review from dictation, handwritten notes, or on own.

4. Opens, annotates, reviews, and processes incoming mail, determining what mail to forward.

5. Processes appointments, updated, deletions to executive schedule determining priorities of meeting. Promotes time management for executive and their schedule.

6. Plans and schedules all travel based on minimum guidelines.

7. Prepares presentation material and provides guidance on format and layout for other administrators within the department.

8. Prepares supply orders.

9. Acts as an administrative resource to others in department.

10. Prepares requests for capital expenditures.

11. Directs copy and fax activities to others.

12. Assists in design of electronic file systems and maintains electronic and paper files.

13. Prepares new hire, security, temporary and other paperwork needed.

14. Assists with projects.

15. Prepares bi-weekly timesheet and PAL requests for executive(s) and processes these and others for signature.

16. Provides financial report support in review of variance reports.

17. Answers phones, screens calls and redirects calls as needed.

18. Maintains contacts for executive.

19. Prepares expense reports from receipts.

20. May coordinate details of major departmental meetings and/or events.

21. Other duties as assigned or needed.

Qualifications:

Education

Required:

High School diploma or equivalent with two years additional education.

Years and Type of Experience Required:

Required:

Minimum of 5 years experience as administrative support to an executive(s) and/or department.

Knowledge of Microsoft Office to include Outlook, Word, PowerPoint, and Excel with at least two years experience using applications.

Specific Technical Skills

Required:

Word, Outlook, PowerPoint, and Excel required with testing scores of 90% or better on overall skills with two years of progressive utilization of software in a business environment.

Ability to exercise judgment and maintain confidentiality.

Excellent organization skills, ability to set priorities and work under pressure to meet changing deadlines.

Excellent proofing skills with strong attention to detail. Must provide documents that are error free.

Excellent verbal and written communication skills and maintain a professional demeanor.

Practices good telephone etiquette skills, customer service and communications skills.

Experience in operating a multi-line telephone and other media devices.

Ability to multi-task while maintaining quality and meeting deadlines.

Preferred:

Experience using Visio in the work environment to develop flow charts, organizational charts, etc.

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/Grand-Prairie-Senior-Administrative-Assistant-Job-TX-75050/908010/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Senior-Administrative-Assistant-Job-TX-75050/908010/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12154
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Sales & Marketing
Type: Regular Full-Time (30+ hours)
Posted Date: 8/13/2010

More information about this job:

Overview:

The Community Liaison works independently to manage the implementation and ongoing development of brand, retention and community strategies. Responsible for professionally representing AMERIGROUP to advocacy groups, organizations, providers and other diverse audiences and populations in a variety of settings, events, and venues. Develops and fosters partnerships and awareness in the community and state by educating and servicing the population as the face of Amerigroup to include: organizational board participation, outreach to existing and potential members, health education and promotion.

Responsibilities:

1. Manages community outreach initiatives to include health information that promotes healthy lifestyles, and information that provides culturally and linguistically appropriate health or nutritional education.

2. Manages member outreach initiatives (FL Plan) to provide information and guidance about social assistance programs

3. Represents AMERIGROUP by participating on Boards and/or committees of significant community organizations to increase awareness of health plan.

4. Develops communication strategies to increase awareness of health plan benefits and services, member retention, and community services that support the population, such as grant proposal, media placement, and marketing materials.

5. Facilitates collaboration of individuals, groups, social service agencies and other community organizations in educational and outreach activities, thus developing interagency groups supporting needs of population.

6. Conducts presentations and performs other activities in an effort to increase health plan awareness and maintains and/or establishes positive relationships with providers, community and faith based organizations.

7. Builds relationships with key providers in the market who have the ability to serve the underserved populations, building the capacity to serve such population.

8. Identifies opportunities to coordinate special events and presentations. Works with team to schedule, set-up, staff and break down events.

9. Participates in product development and enhancement.

10. May develops population surveys and develops specific programming related to survey results (FL Plan).

11. Interviews organizations and/or members to produce success stories/AMERIGROUP Real Stories.

12. Maintains regional marketing analysis to support ongoing evaluation of AMERIGROUP strategy.

13. Promotes company's brand throughout all activities in assigned region.

14. Identifies and collects educational material on community networks and advocacy groups to develop resources so that AMERIGROUP is the subject matter expert for the communities we serve.

15. Complies with state mandated rules, regulations and contractual requirements as well as AMERIGROUP policies and procedures.

16. Other duties as assigned

Qualifications:

Education

Required:

BA/BS degree in healthcare/marketing or equivalent experience.

Years and Type of Experience Required:

Required:

5 years of successful community outreach experience focused on targeted audiences; or 3 years of managed care experience interacting with and providing support to the provider relations network. For Fl Plan only additional 2 years experience working with the SSI/ABD population

Deaf HOH and Blind population

Experience in event planning

Comprehensive understanding of the Medicaid market

Preferred:

Previous experience in outreach to members to include resolution of issues

Previous involvement on boards and/or committees

Successful record of community volunteer work

Managed care experience interacting with and providing support to the provider relations network; including but not limited to responding to inquiries from providers to clarify issues related to member benefits, claim resolution appeal status, provider recruitment and authorization or referral information.

Specific Technical Skills

Required:

Bi-lingual (English/Spanish) (For NJ Plan Only)

MS Office Suite ' Word, Excel, PowerPoint, Outlook and Internet research

Experience with the input and manipulation of data in windows-based applications

Preferred:

Knowledge of proper grant proposals preparationsalesforce.com; demonstrated aptitude to learn technology

Knowledge and understanding of financial terminology, and ability to read and interpret financial reports.

Proficient in American Sign Language (able to serve as an interpreter)

Bi-lingual (English/Spanish)

Certifications or Licensures

Required:

Valid driver's license and have access to an insured motor vehicle for business use.

Other:

Required:

Ability to present products, programs, and services to groups, organizations or individuals to key decision makers and senior level leadership

Social networking and internet marketing communication experience

Displays a high level of initiative. Dynamic individual willing to embrace concepts and develop appropriate programs.

Able to communicate publicly - clearly present information through speaking and/or writing.

Must be able to work non-traditional hours or as needed

evenings and/or weekends

Ability to work independently or as part of a team;

Self-motivated; work with limited supervision.

Able to drive daily within assigned territory; travel within the state for special events, meetings or conferences.

Values and respects the diversity of backgrounds and cultures represented by team members and the target population.

Ability to manage multiple projects and priorities simultaneously (multi-task oriented)

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/Grand-Prairie-Community-Liaison-Plan-Job-TX-75050/908014/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Grand-Prairie-Community-Liaison-Plan-Job-TX-75050/908014/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS
Job ID: 2010-12157
# Positions: 1
Location: US-TX-Grand Prairie
Search Category: Medical Director
Type: Regular Full-Time (30+ hours)
Posted Date: 8/13/2010

More information about this job:

Overview:

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

Responsibilities:

PRIMARY RESPONSIBILITIES:

1. Responsible and accountable to the Chief Medical Director for helping to manage health plan medical costs and assuring appropriate health care delivery for AMERIGROUP health plans, products and services. Reports organizationally to the Chief Medical Director of the Health Plan; has a dotted line relationship to the Chief Medical Officer.

2. Plans, organizes, and directs the professional medical services program, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.

3. Designs and implements health plan medical policies, goals and objectives.

4. Provides professional leadership and direction to the functions within the Medical Management Department (Utilization/Cost Management and Clinical Quality Management).

5. Responsible for and assists with the development of budgets, staffing plans and medical loss ratio projections, assuring the adequate allocation of resources to the medical management functions.

6. Responsible and accountable for implementing the Utilization/Cost Management Program and Clinical Quality Improvement Program.

7. Assists the Chief Medical Director with activities to promote positive community relations.

8. Assures plan conformance with legal and regulatory requirements.

9. Assists the Chief Medical Director in creating and maintaining a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks.

10. Assists the Chief Medical Director in designing and implementing corrective action plans to address issues and improve plan and network managed care performance.

11. Collaborates with Corporate Medical Affairs and the health plan Chief Medical Director in creating and maintaining programs that incentive providers to achieve selected utilization/cost and quality outcomes.

12. Participates in policy review, performs analysis and makes recommendations.

13. Participates in the retrospective review and analysis of Plan performance from summary data of paid claims, encounters, authorization logs, compliant and grievance logs and other sources.

14. Achieves and maintains benchmarked utilization and cost management (UM) goals and clinical quality improvement (QI) objectives.

15. Provides periodic written and verbal reports and updates as required in the Quality Management Program description, the Annual Work Plan and AMERIGROUP Community Care policy and procedures to various plan committees, the health plan Chief Medical Director and Corporate Medical Affairs.

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

17. Supports pre-admission review, utilization management, and concurrent and retrospective review process.

18. Participates in risk management, claim adjudication, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orientation, credentialing, profiling, etc.

19. Conducts quality improvement and outcomes studies as directed by the state Departments of Health, the Quality Management Committee, Medical Advisory Committee, Peer Review Committee and management. Reports findings.

20. Participates in the grievance process with the Chief Medical Director, insuring a fair outcome for all members.

21. Monitors member and provider satisfaction survey results and implements changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants.

22. Participates actively in provider recruitment.

23. Assists the contracting process of providers, hospitals, ancillary providers, and emergency and other support services, and evaluates the medical aspects of provider contracts.

24. Chairs (or delegates leadership of) Advisory Committees of the health plan which include (but are not limited to) the Peer Review Subcommittee and the Credentialing Subcommittee of the Quality Management Committee.

25. Participates in key marketing activities and presentations.

26. Promotes wellness and ensures programs of prevention, education and outreach to members and providers consistent with AMERIGROUP's mission, vision and values.

27. Maintains up-to-date knowledge of new information and technologies in medicine and their application to the AMERIGROUP health plan.

28. Performs and oversees in-service staff training and education of professional staff.

29. Represents AMERIGROUP at medical group meetings, conferences, etc.

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

31. Participates in key marketing activities and presentations, as necessary, to assist the marketing effort.

32. Ensures that the Utilization Management Program is available on a 24 hour basis to respond to authorization requests for emergency and urgent services and is available, at a minimum, during normal working hours for inquiries and authorization requests for non-urgent health care services.

33. The Associate Medical Director must ensure that a covered person enrolled in the Plan is permitted to: a. choose or change a primary care physician from among participating providers in the provider network; and b. when appropriate, choose a specialist from among participating network providers following an authorized referral, if required by the carrier, and subject to the ability of the specialist to accept new patients.

Qualifications:

EDUCATION AND EXPERIENCE:

Education Required: Continuing education to remain current in medical and management areas.

Preferred: Masters in Public Health, MBA, or MA preferred

Years and Type of Experience Required: Required:

5 years of clinical experience in the practice of medicine, 2 of which have been in medical and/or health administration.

3 years of management and/or clinical experience in a managed care environment.

Certifications or Licensure Required: Must be licensed in the Plan State as a Doctor of Medicine or a Doctor of Osteopathy. Active license to practice medicine without restriction issued by the State Board of Licensure or the State Board of Osteopathic Examiners. Certified in a recognized medical specialty as recognized by the American Board of Medical Specialists (ABMS).

Preferred: Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management.

Other Any equivalent combination of education and experience.

Required:

' Management skills to meet the organizational goals.

' Must possess excellent communications skills to interface with providers, staff, and management.

' Knowledge of medical, quality improvement and UM practices in a managed care environment.

' Knowledge of regulatory and accreditation agencies and requirements.

' Able to manage multiple priorities and deadlines in an expedient and decisive manner.

' Able to manage difficult peer situations arising from medical care review.

' Appreciation of cultural diversity and sensitivity towards target population.

PHYSICAL REQUIREMENTS

' Must be able to operate a computer.

' Must be able to operate a telephone.

' Must be able to travel on common carriers and to adhere to AMERIGROUP's travel policies.

' Must be able to operate a motor vehicle. ' Must be able to conduct and participate in meetings]]> http://www.amerigroup-jobs.com/job/Houston-Associate-Medical-Director-Job-TX-77001/908017/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS http://www.amerigroup-jobs.com/job/Houston-Associate-Medical-Director-Job-TX-77001/908017/?utm_source=J2WRSS&utm_medium=rss&utm_campaign=J2W%5FRSS