Author: MM_ADMIN

 
 

Humana Inc. Birmingham, AL

director public policy medicaid health advocacy public policy regulatory healthcare corporate affairs enterprise people trade team

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Job InformationHumanaDirector of State Public PolicyinBirminghamAlabamaDescriptionHumana is an $80 billion (Fortune 41) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.Against that backdrop, we are seeking a talented professional to join our team as Director, State Public Policy. This role resides within the Corporate Affairs Department and will serve as an expert in state public payer, Medicaid and Duals public policy while working with subject matter experts and business units within the Humana enterprise including our Retail, Provider, Healthcare Services, and Humana Pharmacy Solutions (HPS) business units.You will be an instrumental part of Corporate Affairs at Humana by assisting in the development of Humana’s public policy positions for our public payer businesses with an emphasis on Medicaid, Medicare Supplement, state retiree, Duals policy, and future state public health programs. This will require you to engage across the company to analyze public policy, develop positions, and draft deliverables supporting Humana business strategy.We are open as to where this position can be located, but cities in Kentucky, Florida, Illinois, Ohio, Texas, Wisconsin, or Washington D.C. would be ideal.ResponsibilitiesUnder direction of the Vice President of Strategy and State Affairs, and with input from enterprise subject matter experts, analyze, draft, and develop state public payer policy positions to support the enterprise’s priorities.Performs necessary research and analyses to support enterprise positions and priorities.Provides regulatory guidance, general issue management and strategic stakeholder engagement support to Corporate Affairs and business leaders.Develops and maintains an archive of legislative and regulatory analyses, policy briefs, reports, position statements, and other materials pertinent to Humana’s public payer policy and advocacy work.Works closely with Humana Medicare, Medicaid and other lines of business to develop value propositions, white papers and other advocacy materials which support state business development opportunities.Drafts and communicates concise and clear descriptions/analyses/summaries of key issues to Corporate Affairs and Humana businesses.Monitors state Medicaid trends. Contributes policy expertise to state-level advocacy efforts on public payer issues including Medicaid expansion, an extension of Medicaid managed care to new populations and programs, integration of the Duals population and state initiatives that affect the role of managed care in Medicaid programs.Acts as an interface between Humana and national advocacy, trade associations, and public policy organizations; assists in the management of policy consultants; develops external stakeholder outreach strategies.Maintains current awareness and analyzes/compares trends, positions, and issues promoted by other companies, trade, and advocacy organizations active on Medicaid-related issues.Assists in the preparation and drafting of testimony, regulatory comments, and position statements sent to legislative and regulatory bodies and other interested parties concerning legislation, policies, published reports, regulations, and statutes governing Medicaid, long-term services and supports (LTSS), and other waiver programs.Key Candidate QualificationsThe successful candidate will have extensive experience (typically 8 years) in health policy – preferably as a Medicaid, State legislative or executive branch staffer or equivalent experience in Medicaid policy, trade group, law firm, or policy organization. This person will also have strong knowledge of state health administrative/regulatory/licensure rules and guidance as well as state health policy. Key to success will be a proven track record of applied analysis, research, and resource development supporting healthcare policy, and translating information from diverse resources into actionable policy documents for use in an advocacy setting or otherwise. A Bachelor’s degree is required, preferably in health/public policy, economics or health care administration, although a Master’s degree will be a strong plus.In addition to the above, the following professional qualifications and personal attributes are also sought:Prefer demonstrated, strong relationships with policy makers and thought leaders in the state public policy arena.Ability to work in cross-functional teams (matrix environment) including interfacing with business executives to develop and align policy/advocacy positioning with strategic business goals.Prefer an academic background in policy, public affairs, business, or a clinical profession.Solid understanding of relevant policy and regulatory issues and ability to translate complex issues in clear, concise manner to business leaders and advocacy team (technical and non-technical audiences)A passion for the development of innovative, high quality government healthcare programsExperience working in a matrixed organization, with proven ability to work collaboratively through various departments and functional areas, promoting a culture of proactive teamwork.Strong conceptual and creative thinker with an ability to identify trends and interrelationshipsExcellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences internally and externally.Strong creative problem-solving, negotiation, and multi-tasking skills in time-sensitive settings.Highly-developed interpersonal skills with ability to build strong working relationships, internally and externally.Ability to meet clearly stated expectations and take responsibility for achieving resultsWe will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.Scheduled Weekly Hours40

 
 

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The FP&A Manager position will lead the new business development process by providing financial support and modeling for all Request for Proposals (RFP) and Request for Information (RFI), as well as support active health plan business estimated at $14B annual revenue. This position would also support the Business Development team pursuit of $9B annual revenue by preparing and presenting financial proformas to Medicaid leadership. This position will also manage the Capital Investment Process, as well as the Strategic Planning Process for all Medicaid markets in the segment. Other activities that would be included in this role, would be managing the 3rd party vendor requests, cost benefit analysis, return on investment (ROI), and net present value (NPV) calculations. A Candidate should have proven communication skills, as he/she will be expected to present to the Corporate Executives as well as Medicaid’s CEO, CFO, VP of Actuary, VP of Business Development, and RFP Leadership team.


 

• Leads the Capital Investment Process and Strategic Planning Process including all Financial Models, Merger and Acquisition assumptions, Business inputs & Growth targets for all the Medicaid Markets in the segment.
  

– Provides support for the Financial Validation of All Business Cases – Cost, Benefit, Return on Investment (ROI), and Net Present Value (NPV) calculations.

• Leads the Financial Support and Modelling for all Requests for Proposals (RFP) and Requests for Information (RFI).
  
• Responds to all State Specific Requests on Medicaid Market & General and Administrative requests (G&A).
  
• Performs external competitive analysis along with preparing strategic growth financial proformas for leadership review and decision making.
  
• Manage all 3rd party vendor requests and approvals for all of Medicaid including 16 states’ health plans and all corporate shared service areas.
  

Pay Range
The typical pay range for this role is:
Minimum: 60,300
Maximum: 126,600


Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.


Required Qualifications
7+ years’ professional accounting/finance experience with business development and performing advanced financial modeling and analysis


COVID Requirements


COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.


Preferred Qualifications

• Capital Budgeting experience
  
• Advanced degree in Business and/or FSA/CPA
  
• Healthcare industry experience
  
• Government knowledge
  
• The ideal candidate will be a strategic and critical thinker who is highly adaptable and comfortable operating in a changing environment.
  
• Strong communication (verbal, written, presentation) and collaboration skills
  
• High level of proficiency using Excel, Access, and PowerPoint.
  
• Strong analytical, organizational, and problem-solving skills with the ability to multitask while meeting tight deadlines
  

Clipped from: https://www.glassdoor.com/job-listing/manager-fp-and-a-medicaid-cvs-health-JV_KO0,25_KE26,36.htm?jl=1008110968442&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Location: Company:

 
 

Description
Humana Healthy Horizons in Louisiana is seeking a Manager, Utilization Management (Behavioral Health) who will utilize clinical skills to support the coordination, documentation, and communication of behavioral health services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health applies a Person-Centered approach, works within specific guidelines and procedures; applies advanced technical knowledge and clinical criteria to solve moderately complex problems; receives assignments in the form of team and/or department goals and objectives and determines approach, resources, schedules and monitors success of appropriate team or department S.M.A.R.T goals.
Responsibilities
Essential Functions and Responsibilities
– Supervise utilization management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review, prior authorization and referrals to care management.
– Oversee, monitor, orient and train staff in the use of standard utilization management criteria including ASAM.
– Lead development of utilization management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
– Collaborate with internal departments, providers, and community partners to support the delivery of high-quality utilization management services, including introducing innovative approaches to utilization management.
– Monitor and maintain staffing levels to meet care and service quality objectives.
– Conduct timely evaluations of direct reports and provide regular opportunities for professional development.
– Influence and assist corporate leadership in strategic planning to improve effectiveness of behavioral health utilization management programs.
– Collect and analyze performance reports on utilization management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
– Conducts briefings and area meetings; maintains frequent contact with other managers across the department and the company.
Required Qualifications
– Must reside in the state of Louisiana.
– Licensed Mental Health Practitioner (LMHP) who is licensed to practice independently in Louisiana and is in compliance with the requirements of one of the following regulated areas: Medical Psychologists, Licensed Psychologists, Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), Licensed Addiction Counselors (LACs) or Advanced Practice Registered Nurses (APRN) with specialization in adult psychiatric and mental health.
– Two (2) or more years of clinical experience working with the behavioral health populations preferably in an acute care, skilled or rehabilitation clinical setting.
– Previous experience in utilization management.
– Two (2) years of leadership experience.
– Knowledge of ASAM, Interqual and/or Milliman (MCG) criteria.
– Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
– Ability to work independently under general instructions and with a team.
– Must have the ability to provide a high speed DSL or cable modem for a home office.
– A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
– Satellite and Wireless Internet service is NOT allowed for this role.
– A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
– This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
– Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
Preferred Qualifications
– Certified Case Manager (CCM) or willingness to obtain within 2 years of employment.
– Experience serving Medicaid, TANF, and/or CHIP populations.
Additional Information
– Workstyle: Remote.
– Travel: 25% in-state travel.
– Direct Reports: up to 12 Associates.
– Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov) (https://ethics.la.gov/boardprocedures.aspx?type=advisory%20opinion)
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40

 
 

 
 

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Director Business Development – Medicaid
 

• SUNRISE Drive, Reston, VA 20192, USA
  
• Full-time
  

Company Description

At hCentive we’re changing the way benefits are managed. Our software helps to simplify the complex world of shopping, enrolling, and managing health, ancillary, and voluntary benefits. As the industry leader in the benefits management space, we proudly support local and state government agencies, insurance brokers, employers and their employees. We’ve proven time and time again that we deliver cutting-edge software solutions that our clients value for business growth and financial success.

Job Description

Position Summary

This critical opportunity is a hybrid position that will combine your product management expertise with your business development acumen. We are seeking an individual that has experience managing product management teams and implementing strategic project management methodologies like Pragmatic Marketing Framework or Optimal Product Process as well as Business Development success selling to State Government HHS, Local Government or related organizations and be intimately familiar with Federal Eligibilities.

The selected individual will embrace the values of integrity, transparency, professionalism and mutual respect and be customer/client focused with superb presentation skills.

Required Skills and Experience

• 10+ years Product Management experience building SaaS products.
  
• 8+ years of documented Business Development success.
  
• Medicare and Human Services policy and domain experience.
  
• Ability and experience in driving complex government sales and deep knowledge of government procurement practices.
  
• Demonstrated success in establishing strategic partnerships with complementary product organizations and systems integrators.
  
• Experience with Health Care Products and Services
  
• Experience building B2B/B2C SAAS products.
  
• Solid experience in proposal preparation.
  
• Strong project management skills with attention to detail and situational fluency and ability to influence and motivate others, and perseverance to handle challenging business situations ls of management.
  
• Excellent written and oral communication skills at multiple levels within an organization.
  

Desired Skills and Experience

• Experience with Product Market Analysis.
  
• Experience writing business plans for new product development.
  
• Understanding of and experience in UX, including strategy, interaction design, and user-centered design.
  
• Business Acumen
  
• Strategic Thinking
  
• Problem Solving/Analysis
  
• Time Management
  

EDUCATION:

 

Bachelor’s Degree in Engineering, Marketing, Business, or related field is required, Master’s Degree preferred

Qualifications

Required Skills and Experience

• 10+ years Product Management experience building SaaS products.
  
• 8+ years of documented Business Development success.
  
• Medicare and Human Services policy and domain experience.
  
• Ability and experience in driving complex government sales and deep knowledge of government procurement practices.
  
• Demonstrated success in establishing strategic partnerships with complementary product organizations and systems integrators.
  
• Experience with Health Care Products and Services
  
• Experience building B2B/B2C SAAS products.
  
• Solid experience in proposal preparation.
  
• Strong project management skills with attention to detail and situational fluency and ability to influence and motivate others, and perseverance to handle challenging business situations ls of management.
  
• Excellent written and oral communication skills at multiple levels within an organization.
  

Desired Skills and Experience

• Experience with Product Market Analysis.
  
• Experience writing business plans for new product development.
  
• Understanding of and experience in UX, including strategy, interaction design, and user-centered design.
  
• Business Acumen
  
• Strategic Thinking
  
• Problem Solving/Analysis
  
• Time Management
  

EDUCATION:

 

Bachelor’s Degree in Engineering, Marketing, Business, or related field is required, Master’s Degree preferred

Additional Information

hCentive is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

All your information will be kept confidential according to EEO guidelines.

Director Business Development – Medicaid

Clipped from: https://www.learn4good.com/jobs/reston/virginia/business/1449272422/e/

 
 

Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members’ experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY: The Risk Adjustment Analyst will utilize and evaluate claims, authorization, member and provider data to assist the Director of Quality Validation to develop, track and monitor healthcare quality metrics, cost and make recommendations to support business decisions.  The Risk Adjustment Analyst will exhibit familiarity with using data from various relational databases.   The Risk Adjustment Analyst generates departmental performance reports, validates results and makes recommendation on how to interpret information. Performs other duties as assigned.

MINIMUM QUALIFICATIONS:
Education/Specialized Training/Licensure: Bachelor’s Degree in Business. Public Health, Mathematics or related field.  Master’s degree, MBA or MHA preferred.

Work Experience:

• Two  (2)  years of work experience in Analytics, Reporting, Business Intelligence or related area preferred.  
  
• Two (2) years in Healthcare highly preferred.
  
• Experience working on Commercial Risk Adjustment  is preferred   
  
• Experience with SQL query writing and using reporting tools (e.g. MS Excel, SQL Reporting Services, Power BI etc.).
  
• Basic Medical knowledge of ICD9 and ICD10 codes preferred.
  

Software Operated: Microsoft Office (Word, Outlook, Excel)

Other Requirements
– Knowledge of data analysis methodology, understanding of data analytic tools and good communication and documentation skills.
– Experience developing actionable reporting using key metrics communicated in an easy to understand manner.

SPECIAL REQUIREMENTS: 

Communication Skills:
Above Average Verbal (Heavy Public Contact)
Writing /Composing: Correspondence / Reports

Other Skills: Analytical, Mathematics, Medical Terminology, MS Word, MS Excel

 Clipped from: https://jobs.harrishealth.org/risk-adjustment-analyst-community-health-choice/job/19156355?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Resp & Qualifications

PURPOSE:
Provide direct support to ensure that patients move through the system and receive the treatment and services they require. Incumbent will work to bring all aspect’s of a patient’s care together including follow-up appointments, record management as well as care management.


ESSENTIAL FUNCTIONS:

• Establish and promote collaborative working relationships with Care Managers, Social Workers and Nurses.
  
• Assists in referral process by transmitting required patient documentation and verifies that facility received documentation.
  
• Prepare, complete and distribute information packets. Initiate process to follow-up for any information missing.
  
• Facilitate effective exchange of information with facility liaisons, home care liaisons and suppliers.
  
• Assist in obtaining authorizations for transition to next level of care
  
• Provide clerical and support functions to Care Management staff members.
  

QUALIFICATIONS:


Education Level: High School Diploma


Experience: 3 years related administrative and/or health insurance experience.


Knowledge, Skills and Abilities (KSAs)

• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
  

 
 

Department

Department: DC Medicaid – Government Program

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

#LI-LY1

 
 

Clipped from: https://www.glassdoor.com/job-listing/care-manager-assistant-dc-medicaid-carefirst-bluecross-blueshield-JV_IC1138213_KO0,34_KE35,65.htm?jl=1008105882472&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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Care Manager (RN) (Medicaid)

MetroPlus Health Plan New York, NY Full-Time

Empower. Unite. Care.

 

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

 

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth’s network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The primary goal of the Care Manager is to optimize members’ health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member’s needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and evaluate member’s needs, be a creative, efficient and resourceful problem solver. In collaboration with the members’ care team, a plan of care with individualized goals and interventions is developed, implemented and outcomes evaluated.

Job Description

 

• Address member’s problems and needs: clinical, psychosocial, financial, environmental
  
• Provide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivation
  
• Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial and environmental health to improve and maintain lifelong well being
  
• Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
  
• Participate in interdisciplinary rounds
  
• Ensure plans of care have individualized goals and interventions
  
• Communicate plan of care to Primary Care Physician
  
• Address gaps in care with the member and provider
  
• Address members social determinants of health issues
  
• Link members to available resources
  
• Provide care management support during Transitions of Care
  
• Ensure member/caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers
  
• Train member on relevant chronic diseases, preventive care, medication management (medication reconciliation and adherence), home safety, etc.
  
• Provide Complex care management including but not limited to; ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports
  
• Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options
  
• Employ critical thinking and judgment when dealing with unplanned issues
  
• Maintain knowledge of Chronic Conditions and use job aids as a guidance
  
• Maintain accurate, comprehensive and current clinical and non-clinical documentation in DCMS, the Care Management System
  
• Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process
  
• Maintain professional competencies as a Care Manager
  
• Other duties as assigned by Manager
  

Minimum Qualifications

 

• Background: Registered Nurse, Bachelor’s Degree in Nursing required
  
• An equivalent combination of training, educational background, and experience in related fields such as hospital, home care, ambulatory setting and educational disciplines. Prior experience in Care Management in a health care and/or Managed Care setting preferred
  
• Proficiency with computers navigating in multiple systems and web- based applications
  
• Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
  
• Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
  
• Time management and organizational skills
  
• Strong problem-solving skills
  
• Ability to prioritize and manage changing priorities under pressure
  
• Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
  
• Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required
  
• If needed, ability to travel within the MetroPlus service area to participate in facility visits, community events, home visits or other community meetings, including conferences.
  
• Registered Nurse or LMSW/LCSW with current NYS license
  

Professional Competencies:

• Integrity and Trust
  
• Customer Focus
  
• Functional/Technical Skills
  
• Written/Oral Communications
  

Recommended Skills

• Attention To Detail
  
• Certified Nurse Practitioner
  
• Claim Processing
  
• Clinical Works
  
• Coaching And Mentoring
  
• Communication
  

 
 

Clipped from: https://www.careerbuilder.com/job/J3Q1R56BD8TTF59QRNX?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic