A great job awaits! http://caresource.isg2.com/menu.asp?sst=isg-lightblue en-us Thu, 02 Sep 2010 16:59:19 GMT © 2010 HR Services, Inc. Job Summary: Product Managers are responsible for the management of a product line or group of product lines including defining the market strategy, product offering, positioning, forecasting, promotion and overall life cycle management. They are also responsible for ensuring that operational objectives are met through oversight and coordination of activities with strategic business partners relative to assigned products. In addition, Product Managers develop strategic plans for designated product(s) that identify market trends, assess the competitive environment, and support focus areas for the company. They also lead the cross-functional effort to initiate new product strategies in the form of supporting existing brands and creating new products, and they evaluate the needs of member and provider sales personnel and provide direction/support regarding product promotions. Essential Functions: • Continuously analyze and review product(s) performance. • Create and maintain reporting processes that provide insight needed for operational decision-making. • Monitor competitive environment and develop and maintain ongoing strategies to strengthen product position. • Lead the marketing development effort to bring new products from concept through operational stability, including market exit (if applicable). • Actively participate in assigned project teams. Acquire product information through market research and strategic partner input to assure projects meet the needs of the intended markets. • Work across multiple internal and external groups such as regulatory, marketing/communications, care management, finance and operations. • Maintain high level of product knowledge by staying current in published information, regional market activities, and industry meetings. • Drive content and delivery of product education and promotion with internal teams, the sales and distribution network and customers. • Prepare annual product marketing plan, sales forecast, and budget. • Initiate product improvements and changes to meet changing market needs. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=494492&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=494492&B_ID=20&fid=1 Thu, 02 Sep 2010 16:59:00 GMT Job Summary: To coordinate, oversee, and provide administrative secretarial and clerical support activities for designated Care Management staff. Essential Functions: • Expedite written communications for in a timely manner to include: transcription, drafting, typing, and mailing/distribution of a variety of documents (e.g. letters, memorandums, minutes, presentations, and reports); reviews composition, spelling and grammar on a regular basis. • Functions in support role to the designated Management staff including: responsibility for leave slips, calendar and submission to payroll, plans, develops and arranges reservations for travel and meetings, answers calls and takes messages, as appropriate, ensures that back-up is available when not at desk to answer calls, and completes expense reports. • Responsible for coordinating daily schedule/activities of Care Management staff as indicated and maintaining calendars, arrange all travel and prepare expense reports; notify executives of any conflicts. • Maintains and updates various databases and/or patent registries for the department in Microsoft ACCESS or Excel. • Plan/develop social functions for presentations, meetings, etc. • Inform executive of all changes that would impact projects and proactively offer solutions to ensure smooth workflow. • Organize and maintain all files for executive and company files for committee meetings. • Functions in support role for the company including providing Receptionist coverage. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=490710&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=490710&B_ID=20&fid=1 Fri, 27 Aug 2010 00:00:00 GMT Initiate telephonic contact with new members, welcome them to the plan, convey benefit information, and perform initial health risk screening to ensure early identification of members needing case management services. Assist in education of members regarding health care access and benefits. https://www.appone.com/MainInfoReq.asp?R_ID=493588&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=493588&B_ID=20&fid=1 Wed, 25 Aug 2010 00:00:00 GMT Use decision support software in order to perform telephonic clinical triage and health information services for CSMG managed health plans and external clients. Function as a patient advocate by facilitating accessibility to healthcare and provide collaborative services for other CSMG departments. https://www.appone.com/MainInfoReq.asp?R_ID=493258&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=493258&B_ID=20&fid=1 Mon, 23 Aug 2010 00:00:00 GMT Job Summary: The VP Operations is accountable for collaborating with the COO to create the strategy and policy for and to manage Claims, Performance Improvement, Enrollment and Service Operations. Essential Functions: • Direct and manage Performance Improvement, Claims, Enrollment and Service Operations via effective management of direct reports. • Meet with parties to assure that objectives are being defined and achieved • Oversee preparation of internal budget, financial forecasting and analysis • Create comprehensive operational reports, and present on a monthly basis. • Develop and maintain an in-depth knowledge of the company’s business and regulatory environments. • Take an active role in trade and professional organizations in order to help influence organizational objectives. • Assist in strategic and business planning. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=494490&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=494490&B_ID=20&fid=1 Fri, 20 Aug 2010 00:00:00 GMT Job Summary: Provides team leadership in the area of software quality to manage the requirements and testing process of assigned application development. Provide supervision for the daily tasks and projects of the staff. Work closely with customers, business partners, project managers, and team members to understand business requirements. Analyze and design of software quality solutions. This position will work with Developers and Department Managers to develop, maintain, implement and execute a quality assurance process. The role is responsible to develop routine tests, and coordinate the testing efforts for all assigned applications and code base. A certain degree of creativity and latitude is required in assisting management team in resolving complex problems or operational issues. Essential Functions: People management of personnel • Works with staff to set performance goals and objectives • Provide daily supervision and review of work products • Provide feedback on performance on a regular basis • Provide technical guidance, training, and work direction • Ability to guide others in the assigned areas of responsibility • Strong learning competency and ability to teach others. • Troubleshooting and problem solving capabilities • Project planning skills and abilities Software Quality Analysis • Complete business analysis • Review team documents for completeness; providing input and direction to maintain the standards integrity of documentation • Manage the requirements gathering process; direct a small team as assigned • Obtain and document business and system requirements • Document workflows • Provide requirements to development teams and participate in collaborative design sessions • Create and document test cases for all documented requirements • Manage and execute testing for all test cases: types include integration, certification, user acceptance, system, regression, and load tests. • Monitor, measure, and report metrics based on the results of all tests • Evaluate and test new or modified software programs and software development procedures used to verify programs function according to user requirements and conform to established guidelines • Write, revise, and verify quality standards and test procedures for program design and product evaluation in order to economically and efficiently attain a high quality of software • Document quality assurance practices • Initiate improvements to quality controls and documentation procedures • Develop and maintain test plans, manual and automated test scripts for user interface, functionality, system and "ad-hoc testing" • Execute regression tests, functional tests and data tests • Report, track and determine priority of reported bugs promoting quality achievement and performance improvement • Maintain awareness of the business context of software • Ensure compliance with local, state, national and international standards and legislation • Define quali https://www.appone.com/MainInfoReq.asp?R_ID=491756&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=491756&B_ID=20&fid=1 Fri, 20 Aug 2010 00:00:00 GMT Provide support, direction and assistance to CM staff. Give effective and timely feedback to staff in regards to performance outcomes and progress toward goals. Assist with integration of CM and Outreach services to meet departmental goals and objectives. https://www.appone.com/MainInfoReq.asp?R_ID=492832&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=492832&B_ID=20&fid=1 Fri, 20 Aug 2010 00:00:00 GMT Job Summary: Responsible for accurate and timely processing of claims. Essential Functions: • Accurately process medical, facility and/or dental claims for Medicaid and Medicare members. • Research and process COB (Coordination of Benefit) claims. • Meet production and quality goals for claim processing and payment. • Perform claim adjustments and recoveries. • Process and respond to provider inquiry intakes from the Service Center. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=493794&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=493794&B_ID=20&fid=1 Wed, 18 Aug 2010 00:00:00 GMT Job Summary: Drive development of Sales strategy for all products/markets including distribution mix, resource planning, market analysis/targeting and collaborate with Marketing for advertising/materials support to assure achievement of Sales goals. Essential Functions: Business Analysis • Leverage internal and external reporting as well as your own Excel-based analysis to have complete understanding of the numbers that drive the business and use that knowledge to assure targeted, successful strategy development. • Work closely with Finance to develop all membership projections for all products/markets Reporting/planning/strategy • Manage monthly membership report out to the organization • Build detailed, documented Sales plans for annual planning as well as any specific Sales opportunities like open enrollment or a new addition to the network. • Leverage understanding metrics to identify market issues/opportunities and develop mitigation strategies. • Provide summaries to the Vice President of Sales and Marketing on productivity and results as requested. • Manage system for collecting and analyzing competitive information Sales structure/process • Build, maintain and improve all structure and process necessary to assure impeccable regulatory record, achievement of Sales goals and consistency from market to market and product to product. o Compliance system o Accountability for executing Sales plans o Coaching/oversight system o Sales representative reporting and administrative duties o Hiring and onboarding system for new hires o Communication structure o Detailed Sales process o Training process o Expectations for use of technology o Role/organization structure o Performance management system o Measurement system for productivity o Incentive plan design o Execute personnel review system CRM • Play a key role in system selection and implementation • Assure that the markets are getting and using appropriately reporting to manage the business • Assure 100% proper adoption by Sales force New Market/Product/Service Strategy • Integral in analyzing markets/customer segments and recommending mix and selling strategy to maximize launch results and create sustainability of growth https://www.appone.com/MainInfoReq.asp?R_ID=491915&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=491915&B_ID=20&fid=1 Tue, 17 Aug 2010 00:00:00 GMT Job Summary: Responsible for identifying and building relationships with key members of the media and assist in development and execution of proactive and crisis communication management strategies. Essential Functions: • Identify key media relationships with local, state, national and trade media and help develop strategies to assist in “nationalizing” the CareSource brand • Build relationships with traditional and new media contacts using account management skills and tools and leveraging creative strategies to increase frequency and quality of contacts • Manage front line media inquiries • Write press releases, talking points, media alerts and advisories, etc. • Participate in development of strategies to facilitate proactive messaging through the media and effectively manage crisis communication situations • Execute plans to elevate awareness, understanding and support of the CareSource brand and its initiatives • Serve as a new media specialist, identifying non-traditional media (i.e., blogs) opportunities to position CareSource brand. • Identify non-media channels and execute plans to assist in “nationalizing” the CareSource brand (i.e. arranging speaking engagements for CareSource executives, etc.) https://www.appone.com/MainInfoReq.asp?R_ID=486611&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=486611&B_ID=20&fid=1 Thu, 12 Aug 2010 00:00:00 GMT Responsible for providing comprehensive proactive HR generalist services for an area(s) of CSMG including staffing, employee relations, policy development and implementation, performance management, orientation, HR metrics, and legal compliance. https://www.appone.com/MainInfoReq.asp?R_ID=491392&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=491392&B_ID=20&fid=1 Thu, 12 Aug 2010 00:00:00 GMT Job Summary: The Appeals/Grievance Coordinator will research appeals/grievances for Medicaid, Medicare, and future lines of business, to determine the validity of the appeal/grievance. The Appeals/Grievance Coordinator will track, trend, and report appeals/grievances related to existing and future lines of business. Essential Functions: „X Log all appeals/grievances upon receipt in Facets. „X Stamping and sorting of incoming mail and directing or assigning as appropriate. „X Route appeals to appropriate clinical personnel after documenting Facets. „X Identify, sort, and deliver logged appeals/grievances for processing. „X Print and mail letters on denied appeals. „X Providing support to the department, including filing, printing and copying, including the preparation of new case files and State hearing case files. „X Report monthly key statistics for all lines of business to the management team. „X Perform any other job related duties as requested, with reasonable accommodations. „X Adhere to all policies and procedures, and ensure all guidelines set by regulatory bodies are followed and met. „X Other duties as assigned. https://www.appone.com/MainInfoReq.asp?R_ID=492212&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=492212&B_ID=20&fid=1 Tue, 10 Aug 2010 00:00:00 GMT Job Summary: Recruit providers for the network. Contract and educate provider offices of current CMSG policies and procedures. Maintain integrity of relationships through negotiations and contracting. Ensure consistent high level of service and provider satisfaction through visits to high volume providers and recruitment efforts and facilitate timely and effective problem resolution. Essential Functions: • Recruit and negotiate with providers in assigned region. • Provide contact point for large volume and safety net providers and seek contact with these providers so any issues may be resolved and possible issues avoided. These providers will be visited in person multiple times per year. • Review provider panel in assigned region to ensure the minimum provider panel has been satisfied in accordance with State guidelines. • Along with Internal Provider Relations Representatives notify providers of any application that is incomplete and advise provider of any changes that must be made for credentialing information to be finalized. • Ensure timelines and followup of onboarding process are occurring in timely manner. • Understand, gather and utilize market intelligence data as it applies to Network Development. • Follow approved CSMG guidelines to enable providers to become part of CSMG plan. • Educate providers on CSMG Policies and Procedures. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=490779&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=490779&B_ID=20&fid=1 Tue, 10 Aug 2010 00:00:00 GMT Job Summary: Provides leadership, direction and support for all aspects of the Behavioral Health program; ensuring that the organization’s care management policies reflect the concept of integrated behavioral/physical health services Provides direction to all staff working within the Behavioral Health program to enable independent performance that conforms to established program guidelines. The focus of this position is to pursue and achieve best practice in behavioral health care management, disease management, advocacy, and quality improvement programs to ensure consistent, efficient delivery of services, demonstrating positive outcomes, at the same time reducing costs, ensuring a high degree of member, physician and employee satisfaction, and optimal regulatory relationships and compliance. The incumbent must have a strong service orientation and be able to foster strong relationships with Community Mental Health Centers, Federally Qualified Health Centers, hospitals, physicians, community agencies, regulatory and State agencies as well as internal departments and staff. He/she must be skilled as a change agent and be able to work with all levels at CareSource. This position requires significant travel between the corporate office, regional office as well as CMHCs, FQHCs, regulatory and State agency offices, and provider offices and field office sites. Essential Functions: • Works closely with the CareSource Senior and Executive Management team to develop and implement a comprehensive Behavioral/Physical Health Program. • Works closely with the CareSource Senior and Executive Management team to accommodate the growth and expansion of CareSource. • Works closely with CareSource care management staff, medical management staff, behavioral health vendors, behavioral health providers and medical providers to assure integration of behavioral health and medical services. • Works closely with CareSource Senior and Executive Management team to develop recruitment and clinical training programs. • Supervise and mentor Care Management and Disease Management managers; develop and coach employees at all levels in the department. • Continuous review of business workflow to improve productivity and ensure member and provider satisfaction. • Prepare and monitor program budgets for the Behavioral Health program. • Develop and communicate effective program policies and procedures. • Identifies and initiates continuous improvement initiatives. Monitor CQI activities in accordance with regulatory requirements and URAC standards. • Prepares an annual Behavioral Health program Work Plan and annual evaluation of Behavioral Health program activities. • Monitors and evaluates the efficiency and effectiveness of behavioral health activities through analysis and use of relevant data and management reports. • Facilitate and promote problem identification, analysis and resolution. • Determine benchmarks, goals and outcomes for all programs as https://www.appone.com/MainInfoReq.asp?R_ID=492872&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=492872&B_ID=20&fid=1 Tue, 10 Aug 2010 00:00:00 GMT Job Summary: Responsible for operation and management of inbound and outbound care management call center activities to support care management and organizational initiatives while providing exceptional customer service across multiple product lines and states that CareSource conducts business within. Constantly monitor staff performance for quality measures, workload and productivity outcomes. Essential Functions: • Monitor productivity and progress toward care management goals and targets set forth by the Ohio Department of Job and Family Services (ODJFS) such as screening and assessment for new enrollees • Identify and submit system and reporting issues. Monitor status with IT/DSI department. • Work in conjunction with call center analyst in monitoring service levels and analyze for trends • Work in conjunction with Human Resources regarding issues of hiring, interviewing and counseling of potential and current employees. • Respond to requests from various departments and collaborate with them on required projects. • Ensure compliance with URAC/NCQA and regulatory standards • Oversee HEDIS outbound activities • Collaborate with other members of the Care Management management team to implement the Care Transition Program and other Health Services Initiatives. • Provide guidance and instruction for team leads and staff utilizing standardized reviews and formal/informal meetings. • Review and update all CMSS processes such as policies, procedures and workflows. • Perform any other job related instructions as requested, with reasonable accommodation https://www.appone.com/MainInfoReq.asp?R_ID=489906&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=489906&B_ID=20&fid=1 Thu, 05 Aug 2010 00:00:00 GMT Job Summary: Use decision support software in order to perform telephonic clinical health information services for CareSource managed health plans and external clients. Coordinate the care, services and health benefits for selected member populations across the continuum of illness. Monitor and promote effect utilization of healthcare resources through clinical variance and benefits management. Essential Functions: • Complete member assessments by gathering information from the member, family and treatment team. • Develop care plan, defining specific issues, goals and interventions as agreed to by all parties. • Assist in education of members regarding healthcare access and benefits, and provide members with health education and wellness materials. • Verify eligibility, previous enrollment history, demographics and current health status of each member. • Maintain current and accurate documentation of telephonic contacts, treatment plans, case notes, referrals, and assessments in Case Management electronic record. • Maintain appropriate documentation within protocols and guidelines of the Case Management program. • Perform any other job related instructions as requested, with reasonable accommodation. • Participate in learning activities for Case Management proficiency https://www.appone.com/MainInfoReq.asp?R_ID=492750&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=492750&B_ID=20&fid=1 Thu, 05 Aug 2010 00:00:00 GMT Job Summary: Develop and present in-depth analysis that meets the information needs of the organization such as utilization cost analysis, performance comparisons and state measurement requirements. Identify trends and patterns using standard DSI reports and other processes. Assist in analysis of information utilized by the organization for delivering business intelligence. Assist in gathering requirements from various business customers in order to understand specific analytic needs. Work with Decision Support Partners and the Information Delivery team to identify opportunities for process improvement that impact performance, quality, and/or profit through the delivery of business intelligence, analysis and/or reporting. Use professional concepts and knowledge of company policies and procedures to solve a wide range of difficult problems in imaginative and practical ways. Essential Functions: • Conduct examination and explanation of complex data relationships that answer questions identified either within the department or by other departments. • Generate graphics that effectively describe, explore and summarize analysis for communication to appropriate parties. • Incorporate critical thinking skills and judgment in the analysis process to determine best course of action for each inquiry/problem. • Provide information and analyze a variety of data to satisfy managements’ inquiries. • Review reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques that will reveal intelligence for identification of any causal relationship and provide management level summaries that explain key findings. • Provide day-to-day support for analysts. • Use statistical techniques to measure impact of various actions/studies, internal and external, and develop sampling and hypothesis testing to help the organization determine outcomes. • Develop routine operational/analytical reports as needed. • Investigation of data that indicates a significant variation from expected. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=491310&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=491310&B_ID=20&fid=1 Wed, 04 Aug 2010 00:00:00 GMT Job Summary: To coordinate, oversee, and provide administrative secretarial and clerical support activities for the organization in general and specifically to provide administrative/clerical support to designated management staff. Essential Functions: • Expedite written communications for the Executive Management Staff a timely manner to include: transcription, drafting, typing, and mailing/distribution of a variety of documents (e.g. letters, memorandums, minutes, and reports); reviews composition, spelling and grammar on a regular basis. • Function in a support role at the direction of executive assistant. • Responsible for coordinating daily schedule/activities of company management staff as indicated, arrange all travel and prepare expense reports; notify executives of any conflicts. • Establish/maintain office filing systems to facilitate swift location of information. • Operate a variety of office equipment such as typewriters, word processors, personal computers, calculators, etc. • Plan/develop social functions for presentations, meetings, etc. • Maintain tickler file to track events/deadlines and provide follow-up to executive; assist executive with project deadlines. • Inform executive of all changes that would impact projects and proactively offer solutions to ensure smooth workflow. • Occasional operation of main switchboard when necessary. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=489965&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=489965&B_ID=20&fid=1 Sun, 01 Aug 2010 00:00:00 GMT Job Summary: Use decision support software in order to perform telephonic clinical health information services for CareSource managed health plans and external clients. Coordinate the care, services and health benefits for selected member populations across the continuum of illness. Monitor and promote effect utilization of healthcare resources through clinical variance and benefits management. Essential Functions: • Complete member assessments by gathering information from the member, family and treatment team. • Develop care plan, defining specific issues, goals and interventions as agreed to by all parties. • Assist in education of members regarding healthcare access and benefits, and provide members with health education and wellness materials. • Verify eligibility, previous enrollment history, demographics and current health status of each member. • Maintain current and accurate documentation of telephonic contacts, treatment plans, case notes, referrals, and assessments in Case Management electronic record. • Maintain appropriate documentation within protocols and guidelines of the Case Management program. • Perform any other job related instructions as requested, with reasonable accommodation. • Participate in learning activities for Case Management proficiency https://www.appone.com/MainInfoReq.asp?R_ID=489425&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=489425&B_ID=20&fid=1 Sun, 01 Aug 2010 00:00:00 GMT Job Summary: Generate and receive requests for building operations management and provide services to building occupants in the multiple areas of operations and services provided by the Real Estate and Facilities Services department. This position is the first and main point of contact for receiving and prioritizing requests, initiating solutions, scheduling, coordinating and closing out work provided with these services. This position prioritizes work for multiple contracted services including building maintenance technicians, housekeeping, furniture installers and others. Make daily decisions to ensure that business operations are not interrupted and that work assigned has the right level of priority and urgency. On demand service requests will be received from our employees (customers) through a Facilities Management Work Order Management System and will require systems administration, reports development and management for full customer service capabilities. Preventative or planned service requests will be entered into the system and work orders generated from it to allow for the proper frequency of service to all critical building systems. Develop reports from this system to monitor performance, anticipate trends, and manage costs to achieve operational efficiencies. This position primarily supports the 1250 person capacity 325,000 s.f. headquarters building in Dayton Ohio; however, will also support similar work for CareSource remote offices in Michigan, Cleveland and Columbus which supports another 100 employees and 30,000 s.f. of space. Develop and manage the Real Estate and Facilities Management department site for MySource which will be a communications tool for valuable information important to our employees. Essential Functions: • Receive, prioritize, dispatch and track customer service requests for complete management of the 325,000 s.f. HQ building including maintenance operations and facility services. Requests will be received via a Facility Management work order system and calls to the Facilities Service Help Desk phone number. • Schedule and coordinate services and repairs with contracted service companies or internal groups as required. Develop service request and work order logs for reporting and tracking trends, costs, and services by contracted services. • Create purchase orders, receive and process invoices for Real Estate and Facilities Services associated with the operations and services required to manage the building. Track vendor related costs for budget accuracy and cost management. • Act as the Real Estate and Facilities Departmental site administrator for the intranet to develop and maintain the department site that defines and markets the responsibilities and capabilities of the entire facilities services organization through MySource. • Be a strong customer service advocate for the Facilities department to support employee workplace needs and building operations personnel. • M https://www.appone.com/MainInfoReq.asp?R_ID=490615&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=490615&B_ID=20&fid=1 Fri, 30 Jul 2010 00:00:00 GMT Job Summary: Responsible for the coordination, development and maintenance of the Service Operations knowledge repository that houses policies, procedures, process flows, and job aides for service representatives to utilize in response to member and provider call inquiries for Medicaid, Medicare, and future lines of business. Responsible for training and communications to Service Operations staff on new and revised policies, procedures, job aides, and processes flow information within the knowledge repository as changes occur. Essential Functions: • Identify, develop and design information for the knowledge repository for Service Operations functions including Grievance, Appeals, Provider and Member Services. • Collaborate with other departments to develop and/or review cross-functional policies, procedures, process flows, and job aids. • Collaborate with Service Operation’s and Internal Auditing teams on a regular basis to identify new or changing processes. • Attend departmental and project meetings to identify additional policy, procedural, process flow, and job aid information needs. • Job shadow with Service Center Representatives to identify additional policy and procedure needs. • Design and maintain master list of policies, procedures and owners on Share Point. • Develop and communicate the process of updating the policies and procedures when departmental changes occur. • Identify, review and communicate annual policy and procedure updates to appropriate staff and ensure completeness. • Educate employees on changes to the knowledge repository including new and/or revised policies, procedures, process flow, and job aids on an ongoing basis through arranged sessions, staff meetings, new hire training, one on one sessions, Share Point updates and e-mail. • Provide management with opportunities for improvement related to policy, procedural and training functions. • Perform any other job related instructions as requested, with reasonable accommodation https://www.appone.com/MainInfoReq.asp?R_ID=487004&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=487004&B_ID=20&fid=1 Thu, 29 Jul 2010 00:00:00 GMT Job Summary: Customer Service Representative I will assist Medicaid and Medicare members/providers with benefit, claims, and other inquiries. The CSR I provides quality service by immediately responding to the member and/or providers requests and complaints, and appropriately routing issues to the correct department for timely resolution. CSR’s are also required to capture member grievance, and relay appeals instructions for the appropriate line of business, including future lines of business. Essential Functions: • Assist members with routine servicing inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquires, resolving member complaints, identifying and filing member grievances. • Assist a provider with routine servicing inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures. • Ensuring all HIPAA and State requirements/regulations are adhered too at all times, in existing and future lines of business. • Research, follow up, and resolve all open/pending issues in a timely manner to ensure member satisfaction. • Build and strengthen member relationships by providing quality customer service. • Maintain knowledge and understanding of all processes and procedures. • Adhere to all departmental and company policies and procedures. • Maintain complete and accurate documentation of all of telephone and written communications. • Act as a mentor to new hire employees. • Screen members to determine Case Management needs, and refer when appropriate. • Appropriately route calls to support departments including Pharmacy, and Triage, for proper/expedited resolution. • Assist with non phone work such as incoming faxes and web inquires. https://www.appone.com/MainInfoReq.asp?R_ID=486051&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=486051&B_ID=20&fid=1 Thu, 29 Jul 2010 00:00:00 GMT Job Summary: Provide leadership and direction to the Claim Processing teams to ensure the goals and standards of the department and CareSource are being met. Development of cross-functional work teams within the Claims Department. Participate in ongoing development of new products and technologies. Manage projects and inventory aging through effective allocation of resources. Essential Functions: • Guide team leads and analysts relative to daily operational functions. • Ensure quantitative and qualitative measures are used to meet performance objectives. • Manage staffing and scheduling functions. • Engage direct reports through consistent performance feedback and development opportunities. • Compile reports and departmental communications. • Participate in strategic planning and implement action plans. • Interface with team leads on effective people management strategies such as staffing, coaching and mentoring. • Lead/participate in strategic department/company projects. • Identify and facilitate process improvements to improve productivity, accuracy, and data usability. • Maintain positive relationship with internal and external customers. • Perform any other job related duties as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=488831&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=488831&B_ID=20&fid=1 Thu, 29 Jul 2010 00:00:00 GMT Job Summary: Coordinate the care, services and health benefits for selected member populations across the continuum of illness. Monitor and promote effect utilization of healthcare resources through clinical variance and benefits management. Essential Functions: • Develop and implement care plan, defining specific issues, goals and interventions as agreed to by all parties. • Monitor and evaluate care plan on an ongoing basis through member, family and treatment team contact by modifying the plan as needed in conjunction with the prescribed care plan of the treating physician. • Assist in education of members regarding healthcare access and benefits, and provide members with health education and wellness materials. • Participate in meetings with providers to inform them of Case Management services and benefits available to members. • Complete assessments by gathering information from the member, family and treatment team. • Arrange and coordinate services with other healthcare disciplines while maximizing utilization of appropriate community resources and support groups. • Verify eligibility, previous enrollment history, demographics and current health status of each member. • Maintain current and accurate documentation of telephonic contacts, treatment plans, case notes, referrals, and assessments in Case Management electronic record. • Maintain appropriate documentation within protocols and guidelines of the Case Management program. • Perform any other job related instructions as requested, with reasonable accommodation. • Precepting and or mentoring new staff https://www.appone.com/MainInfoReq.asp?R_ID=486530&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=486530&B_ID=20&fid=1 Mon, 26 Jul 2010 00:00:00 GMT Develop new programs, systems and/or computing infrastructure. Identify and document business requirements for new development projects and prepare detailed technical specifications from which programs or infrastructure can be built. Provide day-to-day support and monitoring of the computing systems environment. Assist in hardware/software changes to computing systems environment. https://www.appone.com/MainInfoReq.asp?R_ID=488329&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=488329&B_ID=20&fid=1 Mon, 26 Jul 2010 00:00:00 GMT Job Summary: The Outreach Specialist is responsible for initiating outreach contact with all new members, identifying members who would benefit from case management or disease management services, and maintaining a caseload consisting of members identified with Case/Disease Management diagnosis. The Outreach Specialist must communicate appropriately and effectively with members from diverse cultures. Essential Functions: Employees in this position verify eligibility, previous enrollment history, demographics, and current health status of each member. They maintain accurate documentation of telephone contacts and actions to meet state and federal reporting requirements and to comply with quality assurance standards. They use multiple internal systems including systems for claims, case management and the telephone. Functions include: 1. Welcome Calls • Make initial contact with all new members within the first month of enrollment to welcome them to the plan, convey benefit information and perform initial health risk assessment. • Explain basic managed care concepts, plan benefits and options for appropriate access to care. • Establish positive communications with members via telephonic contact. • Refer and assist members in accessing needed community services within the scope of the Outreach Specialist’s training and serve as a resource for provider offices needing assistance with resource utilization. 2. Health Risk Assessment • Perform data entry of the Health Risk Assessment Tools (HRATs) received in the office. • Appropriately solicit detailed health information from member(s) through telephonic interviewing. • Based on health risk assessment, transfer qualified members to the Nurse Queue for completion of Baseline Assessment 3. Outreach • Initiate outreach contact with members identified from reports. • Initiate outreach contact from member service referrals, medical management referrals, Triage referrals. • Responsible for the explaining Case/Disease Management and benefits provided to the member. 4. Case Load • Collect information and make appropriate contacts with the member’s parents/guardian Maintain members on the case load until member is enrolled within their specified program such as ABD or CSHN, or, member opts out of the program. • Retrieve referrals from Customer Service and make appropriate contacts with the members/guardian. 5. Educational Mailings • Mail educational materials per routing request for Disease Management or Case Management 6. Monthly reporting / case load activities • Report monthly statistics for case management for the Key Statistics report • Create case closure report for audits • Import Pharmacy report into the database and schedule mailings • Verify eligibility on all open cases monthly • Enter health risk assessments received into the database and schedule mailings. 7. Other Functions • Create and submit reports to Manager as requested. Maintain accurate documentation https://www.appone.com/MainInfoReq.asp?R_ID=486654&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=486654&B_ID=20&fid=1 Wed, 21 Jul 2010 00:00:00 GMT Job Summary: Coordinate the care, services and health benefits for selected member populations across the continuum of illness. Monitor and promote effect utilization of healthcare resources through clinical variance and benefits management. Essential Functions: • Develop and implement care plan, defining specific issues, goals and interventions as agreed to by all parties. • Monitor and evaluate care plan on an ongoing basis through member, family and treatment team contact by modifying the plan as needed in conjunction with the prescribed care plan of the treating physician. • Assist in education of members regarding healthcare access and benefits, and provide members with health education and wellness materials. • Participate in meetings with providers to inform them of Case Management services and benefits available to members. • Complete assessments by gathering information from the member, family and treatment team. • Arrange and coordinate services with other healthcare disciplines while maximizing utilization of appropriate community resources and support groups. • Verify eligibility, previous enrollment history, demographics and current health status of each member. • Maintain current and accurate documentation of telephonic contacts, treatment plans, case notes, referrals, and assessments in Case Management electronic record. • Maintain appropriate documentation within protocols and guidelines of the Case Management program. • Perform any other job related instructions as requested, with reasonable accommodation. • Precepting and or mentoring new staff https://www.appone.com/MainInfoReq.asp?R_ID=486636&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=486636&B_ID=20&fid=1 Wed, 21 Jul 2010 00:00:00 GMT Job Summary: This position will manage all aspects of the Health Care Home (HCH) Program. This position will manage all CareSource staff assigned to the Health Care Home Program. This position is responsible for developing and sustaining internal and external relationships with key stakeholders to ensure successful implementation and maintenance of this program. This position will work with DSI and other departments to develop metrics and reports for provider participants and will conduct face-to-face or telephonic meetings with the participants to optimize the relationship and share relevant data to ensure successful outcomes. This position will represent CareSource in the community and with state and local community agencies as appropriate. Developing a positive relationship with key stakeholders represents an opportunity to collaborate on shared issues as well as an opportunity to facilitate better communication and processes to ensure seamless delivery of services to our members optimizing the use of community agencies. This position will be the subject matter expert on practice transformation and will educate internal and external stakeholders on this topic. Manage CareSource Health Care Home Care Management activities and initiatives in collaboration with CareSource departments and community and state agencies to ensure effectiveness of CareSource Health Care Home Program. Essential Functions: • Manage all aspects of the Health Care Home Program. • Manage/supervise all Health Care Home staff. • Serve as a liaison with providers, community agencies, and internal CS staff to facilitate collaboration, process improvement and education so that they are well informed of CareSource benefits, regulatory requirements, current clinical practice guidelines and processes. • Work on development and implementation of processes and procedures to provide management of the Health Care Home Program. • Work with the Care Management management team to ensure adequate staff assignment to the HCH participants. • Develop communications related to the Health Care Home Program on issues, benefits and services (via direct letters, articles in our Provider Newsletter, and on the web). Collaborate with Care Management staff, Provider Relations and Marketing to devise strategies that will keep providers up to date on services, provided feedback on performance and receive feedback from them on ways to improve our services. • Work with CareSource Care Management staff to share information received from local agencies that will improve coordination of care with local agencies and provider participants. • Collaborate with internal CareSource Departments, and provider participants to facilitate communication on state and local agencies on shared initiatives. • Conduct presentations to external providers about internal Care Management activities to foster collaboration regarding care management services within the community. • Perform https://www.appone.com/MainInfoReq.asp?R_ID=486618&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=486618&B_ID=20&fid=1 Wed, 21 Jul 2010 00:00:00 GMT Job Summary: Provide support, direction and assistance to CM staff. Give effective and timely feedback to staff in regards to performance outcomes and progress toward goals. Assist with integration of CM and Outreach services to meet departmental goals and objectives. Essential Functions: • Monitor work allocation to maximize output and effectiveness of staff. • Provide daily oversight of scheduling and attendance of personnel. • Monitor performance of staff members through ongoing audit process. • Provide ongoing training, mentoring, coaching and disciplinary action as needed. Conduct regularly scheduled one-on-one meetings with personnel. • Coordinate team-specific orientation and training. • Manage inbound referrals to CM and appropriately triage them to facilitate CM process. • Serve as interdepartmental liaison for issues relate to CM/Outreach services. • Network with other departments to gather and/or share information. • Assist with development of Case Management/Outreach processes that facilitate cost-effective service utilization and appropriate levels of care. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=486643&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=486643&B_ID=20&fid=1 Wed, 21 Jul 2010 00:00:00 GMT Job Summary: Senior-most source of technical expertise in I.T. Operations (Automation Center of Unified Operations Center). Oversees, develops and implements procedural improvement, work simplification, improvement of manual processes from inception to completion. Assignments are comprehensive and complex and entail interactions between departmental elements and may involve other areas of the organization at various levels of management. Determines, documents and edits Operations procedures and documentation. Develops and tests Operations performance metrics and produces when needed. Trains other team members, including Operations Specialists. Performs daily Operations tasks if necessary. Essential Functions: 1. Provides support and expertise for Operations job automation and scheduling • Automates Operations tasks using Tidal, Power Shell, Batch, Windows Script Host, etc. • Configures Tidal job scheduler to run and track jobs • Automates at least the following IT Operational tasks: o FTP o Application Administration Task o Active Directory Administration Task o Application and System Maintenance o File (Archiving, Moving, Verifying and Editing) o Backup systems and file o EDI file processing 2. Analyzes Operations tasks and functions and identifies opportunities or methods to automate or otherwise improve processes • Identifies and breaks down tasks into components steps • Analyzes Jobs and Job schedule for improvements in quality and performance • Leads and produces deliverables in task automation projects • Determines best tools for automation goals • Defines procedures and standards to be used in achieving automation goals 3. Primary point of contact for Operations putting program changes, enhancements, etc. into IT Production processing • Understands and relates business functional requirements to Operations requirements 4. Defines, documents, and implements Operations procedures 5. Defines and produces Operations performance metrics 6. Provides technical guidance, training, and work direction to Operations team members and Operations Specialists • Demonstrates technical proficiency in automation, automation tools, and the production environment through ability to guide others • Strong learning competency and ability to teach others • Advanced troubleshooting and problem solving capabilities • Mentors and trains Operators and Operations Specialists 7. Provides day-to-day Administration, Support and Monitoring of the computing systems environment • Monitors online systems, files, batch processing, and infrastructure to ensure successful processing • Assists in performance tuning as requested • Performs Active directory user and systems Administration • Performs application User and systems administration • Accurately notifies all applicable constituents of incidents or problem occurrences with daily processing including customers using the systems, IT staff supporting the systems, vend https://www.appone.com/MainInfoReq.asp?R_ID=487509&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=487509&B_ID=20&fid=1 Wed, 21 Jul 2010 00:00:00 GMT Job Summary: Coordinate the care, services and health benefits for selected member populations across the continuum of illness. Monitor and promote effect utilization of healthcare resources through clinical variance and benefits management. Essential Functions: • Develop and implement care plan, defining specific issues, goals and interventions as agreed to by all parties. • Monitor and evaluate care plan on an ongoing basis through member, family and treatment team contact by modifying the plan as needed in conjunction with the prescribed care plan of the treating physician. • Assist in education of members regarding healthcare access and benefits, and provide members with health education and wellness materials. • Participate in meetings with providers to inform them of Case Management services and benefits available to members. • Complete assessments by gathering information from the member, family and treatment team. • Arrange and coordinate services with other healthcare disciplines while maximizing utilization of appropriate community resources and support groups. • Verify eligibility, previous enrollment history, demographics and current health status of each member. • Maintain current and accurate documentation of telephonic contacts, treatment plans, case notes, referrals, and assessments in Case Management electronic record. • Maintain appropriate documentation within protocols and guidelines of the Case Management program. • Perform any other job related instructions as requested, with reasonable accommodation. • Precepting and or mentoring new staff https://www.appone.com/MainInfoReq.asp?R_ID=486479&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=486479&B_ID=20&fid=1 Thu, 15 Jul 2010 00:00:00 GMT Job Summary: Coordinate the care, services and health benefits for selected member populations across the continuum of illness. Monitor and promote effect utilization of healthcare resources through clinical variance and benefits management. Essential Functions: • Develop and implement care plan, defining specific issues, goals and interventions as agreed to by all parties. • Monitor and evaluate care plan on an ongoing basis through member, family and treatment team contact by modifying the plan as needed in conjunction with the prescribed care plan of the treating physician. • Assist in education of members regarding healthcare access and benefits, and provide members with health education and wellness materials. • Participate in meetings with providers to inform them of Case Management services and benefits available to members. • Complete assessments by gathering information from the member, family and treatment team. • Arrange and coordinate services with other healthcare disciplines while maximizing utilization of appropriate community resources and support groups. • Verify eligibility, previous enrollment history, demographics and current health status of each member. • Maintain current and accurate documentation of telephonic contacts, treatment plans, case notes, referrals, and assessments in Case Management electronic record. • Maintain appropriate documentation within protocols and guidelines of the Case Management program. • Perform any other job related instructions as requested, with reasonable accommodation. • Precepting and or mentoring new staff https://www.appone.com/MainInfoReq.asp?R_ID=486436&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=486436&B_ID=20&fid=1 Sat, 10 Jul 2010 00:00:00 GMT Job Summary: Coordinate the care, services and health benefits for selected member populations across the continuum of illness. Monitor and promote effect utilization of healthcare resources through clinical variance and benefits management. Essential Functions: • Develop and implement care plan, defining specific issues, goals and interventions as agreed to by all parties. • Monitor and evaluate care plan on an ongoing basis through member, family and treatment team contact by modifying the plan as needed in conjunction with the prescribed care plan of the treating physician. • Assist in education of members regarding healthcare access and benefits, and provide members with health education and wellness materials. • Participate in meetings with providers to inform them of Case Management services and benefits available to members. • Complete assessments by gathering information from the member, family and treatment team. • Arrange and coordinate services with other healthcare disciplines while maximizing utilization of appropriate community resources and support groups. • Verify eligibility, previous enrollment history, demographics and current health status of each member. • Maintain current and accurate documentation of telephonic contacts, treatment plans, case notes, referrals, and assessments in Case Management electronic record. • Maintain appropriate documentation within protocols and guidelines of the Case Management program. • Perform any other job related instructions as requested, with reasonable accommodation. • Precepting and or mentoring new staff https://www.appone.com/MainInfoReq.asp?R_ID=486448&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=486448&B_ID=20&fid=1 Sat, 10 Jul 2010 00:00:00 GMT Job Summary: Facilitate and evaluate courses on a variety of business and interpersonal skills topics. Assist in the development on new courses based on needs analysis outcomes. Essential Functions: • Facilitate, and evaluate courses on a variety of topics such as, communication skills, customer service, constructive feedback, working in teams, emotional intelligence, etc. • Prepare and facilitate technical tools (Outlook, the Source, managed care) training for new hires • Assist in the development and maintenance of CareSource University Course Catalog and other communication tools • Assist with the development of new courses • Research developments in the fields of training, organizational development, career development and performance improvement https://www.appone.com/MainInfoReq.asp?R_ID=484988&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=484988&B_ID=20&fid=1 Fri, 09 Jul 2010 00:00:00 GMT Job Summary: Assist with Medical Management Processes. Responsible for collection and entry of demographic and service requests information from providers/members into the electronic record. Verify eligibility, enrollment history and demographics of members. Act as point of contact providing medical management assistance to providers and members by maintaining communication through a telephonic and electronic and education/assistance in prior authorization requests. Essential Functions: • Convert information obtained from providers/members, (received via fax, phone or mail) into electronic records. • Facilitate/assist the authorization of benefits for out-of-network providers including completion of appropriate forms that are distributed to physicians’ offices, provider relations and the generation of approval letters. • Complete necessary contact with provider/member to verify newborn information. • Input required data into system for newborns. o Provide authorization number to provider or facility. o Assist PCC team support as directed • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=485847&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=485847&B_ID=20&fid=1 Tue, 06 Jul 2010 00:00:00 GMT Job Summary: Customer Service Representative I will assist Medicaid and Medicare members/providers with benefit, claims, and other inquiries. The CSR I provides quality service by immediately responding to the member and/or providers requests and complaints, and appropriately routing issues to the correct department for timely resolution. CSR’s are also required to capture member grievance, and relay appeals instructions for the appropriate line of business, including future lines of business. Essential Functions: • Assist members with routine servicing inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquires, resolving member complaints, identifying and filing member grievances. • Assist a provider with routine servicing inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures. • Ensuring all HIPAA and State requirements/regulations are adhered too at all times, in existing and future lines of business. • Research, follow up, and resolve all open/pending issues in a timely manner to ensure member satisfaction. • Build and strengthen member relationships by providing quality customer service. • Maintain knowledge and understanding of all processes and procedures. • Adhere to all departmental and company policies and procedures. • Maintain complete and accurate documentation of all of telephone and written communications. • Act as a mentor to new hire employees. • Screen members to determine Case Management needs, and refer when appropriate. • Appropriately route calls to support departments including Pharmacy, and Triage, for proper/expedited resolution. • Assist with non phone work such as incoming faxes and web inquires. https://www.appone.com/MainInfoReq.asp?R_ID=479631&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=479631&B_ID=20&fid=1 Tue, 06 Jul 2010 00:00:00 GMT Job Summary: Customer Service Representative I will assist Medicaid and Medicare members/providers with benefit, claims, and other inquiries. The CSR I provides quality service by immediately responding to the member and/or providers requests and complaints, and appropriately routing issues to the correct department for timely resolution. CSR’s are also required to capture member grievance, and relay appeals instructions for the appropriate line of business, including future lines of business. Essential Functions: • Assist members with routine servicing inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquires, resolving member complaints, identifying and filing member grievances. • Assist a provider with routine servicing inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures. • Ensuring all HIPAA and State requirements/regulations are adhered too at all times, in existing and future lines of business. • Research, follow up, and resolve all open/pending issues in a timely manner to ensure member satisfaction. • Build and strengthen member relationships by providing quality customer service. • Maintain knowledge and understanding of all processes and procedures. • Adhere to all departmental and company policies and procedures. • Maintain complete and accurate documentation of all of telephone and written communications. • Act as a mentor to new hire employees. • Screen members to determine Case Management needs, and refer when appropriate. • Appropriately route calls to support departments including Pharmacy, and Triage, for proper/expedited resolution. • Assist with non phone work such as incoming faxes and web inquires. https://www.appone.com/MainInfoReq.asp?R_ID=482927&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=482927&B_ID=20&fid=1 Tue, 06 Jul 2010 00:00:00 GMT Job Summary: Customer Service Representative I will assist Medicaid and Medicare members/providers with benefit, claims, and other inquiries. The CSR I provides quality service by immediately responding to the member and/or providers requests and complaints, and appropriately routing issues to the correct department for timely resolution. CSR’s are also required to capture member grievance, and relay appeals instructions for the appropriate line of business, including future lines of business. Essential Functions: • Assist members with routine servicing inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquires, resolving member complaints, identifying and filing member grievances. • Assist a provider with routine servicing inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures. • Ensuring all HIPAA and State requirements/regulations are adhered too at all times, in existing and future lines of business. • Research, follow up, and resolve all open/pending issues in a timely manner to ensure member satisfaction. • Build and strengthen member relationships by providing quality customer service. • Maintain knowledge and understanding of all processes and procedures. • Adhere to all departmental and company policies and procedures. • Maintain complete and accurate documentation of all of telephone and written communications. • Act as a mentor to new hire employees. • Screen members to determine Case Management needs, and refer when appropriate. • Appropriately route calls to support departments including Pharmacy, and Triage, for proper/expedited resolution. • Assist with non phone work such as incoming faxes and web inquires. https://www.appone.com/MainInfoReq.asp?R_ID=483157&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=483157&B_ID=20&fid=1 Tue, 06 Jul 2010 00:00:00 GMT Job Summary: Responsible for utilization review and discharge planning activities for members enrolled with a CareSource Management Group (CareSource) line of business, monitoring the appropriate delivery of health care services in a cost effective manner. Maintain knowledge of State and Federal regulations governing CareSource, State Contracts and Provider Agreement, benefits and URAC Standards. Essential Functions: • Prospective, retrospective and concurrent review of inpatient admissions, outpatient procedures, homecare services and durable medical equipment. • Coordinate care and facilitate discharge to an appropriate level of care in a timely and cost-effective manner. • Identify and refer quality issues to Quality Improvement. • Identify and refer appropriate members for Case Management. • Document and communicate with CareSource and Provider Case Managers and Discharge Planners to establish discharge planning needs and coordinate care. • Perform any other job related instructions as requested, with reasonable accommodation. • Provide direction to non-clinical medical management staff. • RN’s - Provide direction to and assist with oversight of LPN, LISW medical management staff. https://www.appone.com/MainInfoReq.asp?R_ID=465975&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=465975&B_ID=20&fid=1 Mon, 05 Jul 2010 00:00:00 GMT Job Summary: Use decision support software in order to perform telephonic clinical health information services for CareSource managed health plans and external clients. Coordinate the care, services and health benefits for selected member populations across the continuum of illness. Monitor and promote effect utilization of healthcare resources through clinical variance and benefits management. Essential Functions: • Complete member assessments by gathering information from the member, family and treatment team. • Develop care plan, defining specific issues, goals and interventions as agreed to by all parties. • Assist in education of members regarding healthcare access and benefits, and provide members with health education and wellness materials. • Verify eligibility, previous enrollment history, demographics and current health status of each member. • Maintain current and accurate documentation of telephonic contacts, treatment plans, case notes, referrals, and assessments in Case Management electronic record. • Maintain appropriate documentation within protocols and guidelines of the Case Management program. • Perform any other job related instructions as requested, with reasonable accommodation. • Participate in learning activities for Case Management proficiency https://www.appone.com/MainInfoReq.asp?R_ID=484697&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=484697&B_ID=20&fid=1 Mon, 28 Jun 2010 00:00:00 GMT Job Summary: Coordinate the care, services and health benefits for selected member populations across the continuum of illness. Monitor and promote effect utilization of healthcare resources through clinical variance and benefits management. Essential Functions: • Develop and implement care plan, defining specific issues, goals and interventions as agreed to by all parties. • Monitor and evaluate care plan on an ongoing basis through member, family and treatment team contact by modifying the plan as needed in conjunction with the prescribed care plan of the treating physician. • Assist in education of members regarding healthcare access and benefits, and provide members with health education and wellness materials. • Participate in meetings with providers to inform them of Case Management services and benefits available to members. • Complete assessments by gathering information from the member, family and treatment team. • Arrange and coordinate services with other healthcare disciplines while maximizing utilization of appropriate community resources and support groups. • Verify eligibility, previous enrollment history, demographics and current health status of each member. • Maintain current and accurate documentation of telephonic contacts, treatment plans, case notes, referrals, and assessments in Case Management electronic record. • Maintain appropriate documentation within protocols and guidelines of the Case Management program. • Perform any other job related instructions as requested, with reasonable accommodation. • Precepting and or mentoring new staff https://www.appone.com/MainInfoReq.asp?R_ID=483622&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=483622&B_ID=20&fid=1 Thu, 24 Jun 2010 00:00:00 GMT Job Summary: The senior data analyst will lead projects that involve working closely with the business to define, document, and apply business rules to enterprise data. They will also design and develop data standards, policies, procedures, and metadata to ensure accuracy, quality, integrity, and optimization of this data. This includes working closely with application and database developers to model existing undocumented databases as well as designing new application databases. Responsibilities also include researching and documenting data requirements for regulatory data submissions and designing database models that facilitate reporting and analysis. Essential Functions: • Develop enterprise data policies and standards and monitor adherence to these standards. • Guide, mentor, and instruct more junior staff members regarding enterprise data management practices. • Ensure the quality of data submitted to regulatory agencies by developing detailed metadata for submissions and monitoring these submissions on an ongoing basis. • Design data models for reporting and analytic databases that translate business and regulatory rules and definitions into query able data structures. • Design data models for development of new transactional systems. • Reverse engineer data models for existing databases and systems. • Design and implement procedures that monitor enterprise data quality and take appropriate action when anomalies occur. • Develop and maintain detailed documentation that provides traceability for all enterprise data back to its source. • Actively participate in projects designed to create record of reference systems for key enterprise data. • Define and adhere to standard metadata naming conventions. https://www.appone.com/MainInfoReq.asp?R_ID=480691&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=480691&B_ID=20&fid=1 Wed, 23 Jun 2010 00:00:00 GMT Job Summary: Coordinate the care, services and health benefits for selected member populations across the continuum of illness. Monitor and promote effect utilization of healthcare resources through clinical variance and benefits management. Essential Functions: • Develop and implement care plan, defining specific issues, goals and interventions as agreed to by all parties. • Monitor and evaluate care plan on an ongoing basis through member, family and treatment team contact by modifying the plan as needed in conjunction with the prescribed care plan of the treating physician. • Assist in education of members regarding healthcare access and benefits, and provide members with health education and wellness materials. • Participate in meetings with providers to inform them of Case Management services and benefits available to members. • Complete assessments by gathering information from the member, family and treatment team. • Arrange and coordinate services with other healthcare disciplines while maximizing utilization of appropriate community resources and support groups. • Verify eligibility, previous enrollment history, demographics and current health status of each member. • Maintain current and accurate documentation of telephonic contacts, treatment plans, case notes, referrals, and assessments in Case Management electronic record. • Maintain appropriate documentation within protocols and guidelines of the Case Management program. • Perform any other job related instructions as requested, with reasonable accommodation. • Precepting and or mentoring new staff https://www.appone.com/MainInfoReq.asp?R_ID=482368&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=482368&B_ID=20&fid=1 Fri, 18 Jun 2010 00:00:00 GMT Job Summary: Coordinate the care, services and health benefits for selected member populations across the continuum of illness. Monitor and promote effect utilization of healthcare resources through clinical variance and benefits management. Essential Functions: • Develop and implement care plan, defining specific issues, goals and interventions as agreed to by all parties. • Monitor and evaluate care plan on an ongoing basis through member, family and treatment team contact by modifying the plan as needed in conjunction with the prescribed care plan of the treating physician. • Assist in education of members regarding healthcare access and benefits, and provide members with health education and wellness materials. • Participate in meetings with providers to inform them of Case Management services and benefits available to members. • Complete assessments by gathering information from the member, family and treatment team. • Arrange and coordinate services with other healthcare disciplines while maximizing utilization of appropriate community resources and support groups. • Verify eligibility, previous enrollment history, demographics and current health status of each member. • Maintain current and accurate documentation of telephonic contacts, treatment plans, case notes, referrals, and assessments in Case Management electronic record. • Maintain appropriate documentation within protocols and guidelines of the Case Management program. • Perform any other job related instructions as requested, with reasonable accommodation. • Precepting and or mentoring new staff https://www.appone.com/MainInfoReq.asp?R_ID=482374&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=482374&B_ID=20&fid=1 Fri, 18 Jun 2010 00:00:00 GMT Job Summary: Responsible for tracking, coordinating, identifying and facilitating member transition into case management under direct supervision of an RN. Responsible for monitoring and maintaining monthly reports, identifying trends and members who are appropriate for case management or other state programs. Essential Functions: • Scores Health Needs Assessment Forms and ensures appropriate routing of identified cases to the RN case manager • Performs disease specific and/or baseline assessments. Collaborates closely with the RN to ensure compliance with department policies/procedures • Identify and assists members for transition to more appropriate state programs. Prepare and monitor monthly report • Acts as the liaison between case management and other departments to identify high cost utilization and facilitates appropriate measures. • Responsible for collection of clinical information and data entry. Prepares case for RN Case Manager. This may include mailing, faxing, and calling provider offices to compile information. • Monitors and educates members specific to targeted disease process as determined by state requirements and/or business initiatives of CSMG. • Perform any other job related instructions as requested by their supervisor, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=481755&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=481755&B_ID=20&fid=1 Fri, 18 Jun 2010 00:00:00 GMT Use decision support software in order to perform telephonic clinical triage and health information services for CSMG managed health plans and external clients. Function as a patient advocate by facilitating accessibility to healthcare and provide collaborative services for other CSMG departments. https://www.appone.com/MainInfoReq.asp?R_ID=477370&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=477370&B_ID=20&fid=1 Thu, 17 Jun 2010 00:00:00 GMT Job Summary: The Provider Resolution Specialist is responsible for capturing, resolving/facilitating resolution, and reporting on escalated complaints regarding claims processing, provider dissatisfaction with payment and denial explanations. This individual will be responsible for identifying trends and recommending improvements related to provider inquires and complaints. Essential Functions: • Ensure that all assigned provider issues are resolved and communicated to the provider within appropriate timeframes and report resolutions that are unfavorable to the appropriate Provider Relations Representative. • Assist providers with escalated inquiries including but not limited to; verifying proper medical coding, explanation of benefits, negative balance requests, claims, and appeal procedures. • Work with Decision Support Informatics (DSI) to develop reporting on provider complaints and inquires and develop recommendations to proactively address complaints and reduce unwarranted inquires. • Examine and identify data to improve plan performance, internal processes and department workflow. Present improvement recommendations and provider education topics to the Operations Enterprise Committee. • Participate in meetings related to claims processing and payment decisions such as, Reimbursement and Benefit and Provider Appeals Workgroup. • Document all inquires and complaints completely and thoroughly. • Identify and lead departmental training and communication as needed. • Ensure reporting on provider inquires and complaints is compliant with current and future regulatory and accreditation bodies such as; ODJFS, MDCH, CMS, OFIR, NCQA and URAC. • Adhere to all HIPAA, State, and Federal requirements and regulations at all times in existing and future lines of business. • Perform any other job related instructions as requested, with reasonable accommodation https://www.appone.com/MainInfoReq.asp?R_ID=481553&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=481553&B_ID=20&fid=1 Thu, 10 Jun 2010 00:00:00 GMT Job Summary: A Customer Service Representative III acts as subject matter expert, while staffing the assist line and accurately responding to inquires presented by a CSR I and II who is servicing Medicaid/Medicare member or provider, including members and providers associated with future lines of business. The CSR III also monitors queue performance, makes necessary staffing adjustments to the queues during peak periods, tracks call trends, and alerts management when necessary. Essential Functions: • Monitor and manage call queues to ensure all Customer Service Representatives are available and appropriately staffed. • Act as a “New Hire Coach” for new employees. • Maintain Outage log and report to management team weekly. • Provide Peer to Peer feedback (daily phone interaction). • Identify training needs for Service Center Representatives. • Manage and process internal route boxes. • Ability to service both member and provider calls in all lines of business, existing and future. • Utilize self-education opportunities to stay abreast of procedural updates – maintain Subject Matter Expert (SME) status in all skill sets. • Act as a mentor to new hire employees. • Answer second level assist questions. • Willingness and ability to assist Customer Service Representatives with questions and inquires. • Document all second level support questions by utilizing and maintaining the Assist Line Tracking Database. • Handle and resolve escalated member and provider complaints. • Act as a role model to other Customer Service Representatives and employees. • Display a positive attitude. • Be helpful and approachable to other Customer Service Representatives and employees. • Be accountable for actions. • Motivate other Customer Service Representatives and employees. • Assist members with routine servicing inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquires, member complaints, identifying and filing member grievances. • Assist providers with routine servicing inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures. • Ensuring all HIPAA and State requirements/regulations are adhered too at all times in existing and future lines of business. • Research, follow up and resolve all open/pending issues in a timely manner to ensure member satisfaction. • Build and strengthen member relationships by providing quality customer service. • Maintain knowledge and understanding of all processes and procedures. • Adhere to all policies and procedures. • Maintain complete and accurate documentation of all of telephone and written communications. • Screen members to determine if they need Case Management and refer when appropriate. • Route calls to appropriate departments including Pharmacy, and Triage, for proper/ex https://www.appone.com/MainInfoReq.asp?R_ID=479652&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=479652&B_ID=20&fid=1 Thu, 10 Jun 2010 00:00:00 GMT Job Summary: Develop unique and innovative enterprise wide, graphics based, reporting solutions that deliver actionable information to the business with a high degree of impact. Perform analysis as needed to support business decision-making. Reporting application development in the SAS Information Delivery Portal will involve database programming, stored process development, both server and client side web development, as well as significant use of the SAS Business Intelligence suite of software including Information Data Map Studio, Web Report Studio, OLAP studio and others. Use BASE SAS to develop graphical output (charts, graphs, control charts, custom graphics, custom reports) for delivery via the SAS Portal. Essential Functions: • Develop, and implement Information delivery solutions in SAS for the purpose of providing business intelligence. • Develop code that graphically represents data in a manner that is user friendly, fully automatable, and supportable. • Incorporate critical thinking skills and judgment in the analysis process to determine best course of action for each inquiry/problem. • Follow established department coding, documentation, and testing standards and procedures. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=478723&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=478723&B_ID=20&fid=1 Sun, 06 Jun 2010 00:00:00 GMT Job Summary: Responsible for the integrity and accurate reporting of the financial position of the CareSource Management Group Company and all affiliated entities Essential Functions: • Ensures financial stewardship for CareSource’s entities by establishing, monitoring and enforcing financial policies and procedures and internal controls. Includes leadership for ensuring the integrity and security of the general ledger and reporting system. • Provides timely, accurate comprehensive and transparent financial reporting including, but not limited to, operating statements, balance sheets, cash flow statements, and key business reports as required in accordance with generally accepted accounting principles and statutory requirements. • Responsible for all statutory financial statement filings for the regulated entities • Manage fiduciary responsibilities for corporate assets. • Coordinates independent financial accounting audits and other regulatory financial related audits. • Proactively researches existing and new legislation, changes in financial accounting standards and NAIC statutory requirements. • Responsible for the management of the accounting staff • Ability to interact with all levels of management as well as external audit management. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=481188&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=481188&B_ID=20&fid=1 Sat, 29 May 2010 00:00:00 GMT Job Summary: Responsible for the integrity and accurate accounting and reporting of the financial position of multiple entities within the CareSource Management Group Company family and the consolidated entity, and ensure operations are in accordance with reporting requirements and appropriate internal controls. Essential Functions: • Prepare and review consolidated monthly financial statement for CareSource Management Group Company. Also, prepare and review monthly financial statements for CareSource Foundation, CareSource Indiana, and CareSource Insurance LLC. • Coordinate SNP reporting for CSO and CSM. Collaborate with CSO Accounting Manager and CSM Accounting Manager as necessary. • Perform monthly CareSource cost allocations in accordance with executed Management Agreements. • Prepare and implement all necessary internal controls for related entities consistent with Model Audit Rule requirements. • Administer audit and report functions, as required. • Collaborate with the Treasurer in the oversight of Corporate Credit Card program and employee expense reimbursement. • Oversee responsibility for corporate fixed asset accounting and reporting. • Coordinate with the CFO and Director of Internal Audit in the independent financial accounting audits of the consolidated GAAP entity. • Ensure on-time filing of all internal and external financial reporting. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=480264&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=480264&B_ID=20&fid=1 Fri, 28 May 2010 00:00:00 GMT Job Summary: Responsible for the integrity and accurate accounting and reporting of the financial position of an area(s)/plan of CareSource, and ensure operations are managed in accordance with regulatory and reporting requirements. Essential Functions: • Prepare and review monthly financial statements, supporting journals, and supplementary schedules. • Maintain compliance with plan reporting requirements to state department of insurance, Medicaid administrator, and department of insurance. • Administer audit and report functions, as required. • Collaborate with the Treasurer in the oversight of investment reporting and performance. • Manage fiduciary responsibilities for plan assets. • Coordinate with the CFO and Director of Internal Audit in the independent financial accounting audits and other regulatory financial related audits pertinent to the plan. • Maintain up to date knowledge of statutory and GAAP accounting. • Perform any other job related instructions as requested, with reasonable accommodation. • ~10% travel required. https://www.appone.com/MainInfoReq.asp?R_ID=480262&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=480262&B_ID=20&fid=1 Fri, 28 May 2010 00:00:00 GMT Job Summary: A Customer Service Representative III acts as subject matter expert, while staffing the assist line and accurately responding to inquires presented by a CSR I and II who is servicing Medicaid/Medicare member or provider, including members and providers associated with future lines of business. The CSR III also monitors queue performance, makes necessary staffing adjustments to the queues during peak periods, tracks call trends, and alerts management when necessary. Essential Functions: • Monitor and manage call queues to ensure all Customer Service Representatives are available and appropriately staffed. • Act as a “New Hire Coach” for new employees. • Maintain Outage log and report to management team weekly. • Provide Peer to Peer feedback (daily phone interaction). • Identify training needs for Service Center Representatives. • Manage and process internal route boxes. • Ability to service both member and provider calls in all lines of business, existing and future. • Utilize self-education opportunities to stay abreast of procedural updates – maintain Subject Matter Expert (SME) status in all skill sets. • Act as a mentor to new hire employees. • Answer second level assist questions. • Willingness and ability to assist Customer Service Representatives with questions and inquires. • Document all second level support questions by utilizing and maintaining the Assist Line Tracking Database. • Handle and resolve escalated member and provider complaints. • Act as a role model to other Customer Service Representatives and employees. • Display a positive attitude. • Be helpful and approachable to other Customer Service Representatives and employees. • Be accountable for actions. • Motivate other Customer Service Representatives and employees. • Assist members with routine servicing inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquires, member complaints, identifying and filing member grievances. • Assist providers with routine servicing inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures. • Ensuring all HIPAA and State requirements/regulations are adhered too at all times in existing and future lines of business. • Research, follow up and resolve all open/pending issues in a timely manner to ensure member satisfaction. • Build and strengthen member relationships by providing quality customer service. • Maintain knowledge and understanding of all processes and procedures. • Adhere to all policies and procedures. • Maintain complete and accurate documentation of all of telephone and written communications. • Screen members to determine if they need Case Management and refer when appropriate. • Route calls to appropriate departments including Pharmacy, and Triage, for proper/ex https://www.appone.com/MainInfoReq.asp?R_ID=478244&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=478244&B_ID=20&fid=1 Sun, 23 May 2010 00:00:00 GMT Job Summary: A Customer Service Representative III acts as subject matter expert, while staffing the assist line and accurately responding to inquires presented by a CSR I and II who is servicing Medicaid/Medicare member or provider, including members and providers associated with future lines of business. The CSR III also monitors queue performance, makes necessary staffing adjustments to the queues during peak periods, tracks call trends, and alerts management when necessary. Essential Functions: • Monitor and manage call queues to ensure all Customer Service Representatives are available and appropriately staffed. • Act as a “New Hire Coach” for new employees. • Maintain Outage log and report to management team weekly. • Provide Peer to Peer feedback (daily phone interaction). • Identify training needs for Service Center Representatives. • Manage and process internal route boxes. • Ability to service both member and provider calls in all lines of business, existing and future. • Utilize self-education opportunities to stay abreast of procedural updates – maintain Subject Matter Expert (SME) status in all skill sets. • Act as a mentor to new hire employees. • Answer second level assist questions. • Willingness and ability to assist Customer Service Representatives with questions and inquires. • Document all second level support questions by utilizing and maintaining the Assist Line Tracking Database. • Handle and resolve escalated member and provider complaints. • Act as a role model to other Customer Service Representatives and employees. • Display a positive attitude. • Be helpful and approachable to other Customer Service Representatives and employees. • Be accountable for actions. • Motivate other Customer Service Representatives and employees. • Assist members with routine servicing inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquires, member complaints, identifying and filing member grievances. • Assist providers with routine servicing inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures. • Ensuring all HIPAA and State requirements/regulations are adhered too at all times in existing and future lines of business. • Research, follow up and resolve all open/pending issues in a timely manner to ensure member satisfaction. • Build and strengthen member relationships by providing quality customer service. • Maintain knowledge and understanding of all processes and procedures. • Adhere to all policies and procedures. • Maintain complete and accurate documentation of all of telephone and written communications. • Screen members to determine if they need Case Management and refer when appropriate. • Route calls to appropriate departments including Pharmacy, and Triage, for proper/ex https://www.appone.com/MainInfoReq.asp?R_ID=478893&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=478893&B_ID=20&fid=1 Sun, 23 May 2010 00:00:00 GMT Job Summary: Recruit providers for the network. Contract and educate provider offices of current CSMG policies and procedures. Maintain integrity of relationships through negotiations and contracting. Ensure consistent high level of service and provider satisfaction through visits to high volume providers and recruitment efforts and facilitate timely and effective problem resolution. Essential Functions: • Recruit and negotiate with providers in assigned region. • Provide contact point for large volume and safety net providers and seek contact with these providers so any issues may be resolved and possible issues avoided. These providers will be visited in person multiple times per year. • Review provider panel in assigned region to ensure the minimum provider panel has been satisfied in accordance with State guidelines. • Along with Internal Provider Relations Representatives notify providers of any application that is incomplete and advise provider of any changes that must be made for credentialing information to be finalized. • Ensure timelines and followup of onboarding process are occurring in timely manner. • Understand, gather and utilize market intelligence data as it applies to Network Development. • Follow approved CSMG guidelines to enable providers to become part of CSMG plan. • Educate providers on CSMG Policies and Procedures. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=478918&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=478918&B_ID=20&fid=1 Fri, 21 May 2010 00:00:00 GMT Provide top-tier support and design of contact center and telecommunication systems. Responsible for technical design, implementation and support of voice communications infrastructure on local/wide area networks, firewalls and other network security devices. • Understanding and experience with IP and TDM based PBX/PABX and ACD systems. • Understanding of CTI middleware integration with Business Applications, such as CRM , ERP (Enterprise Resource Planning), Workforce Management, Quality Management, Outbound Dialing and Voice/Data Monitoring. • IVR Technologies - Knowledge of Cisco Voice Portal and carrier IVR/VRU systems and solutions. • Experience with XML and VXML • Knowledge of Advanced Speech Recognition and Text-to-Speech offerings • Understanding of, experience with, and exposure to messaging and personal productivity applications such as UNITY, Personal Assistant, and IP Phone Productivity Applications • Understanding of, experience with, and exposure to IP Telephony, including Cisco Unified Communications Manager (CUCM), IP Phones, XML Applications, Meeting Place, Emergency Responder, and Telephony Applications • Understanding of Cisco’s UCCE/IPCC Enterprise Solution • Hands-on experience with carrier Intelligent Network services from companies such as AT&T and Qwest, including toll-free service, network routing, call forwarding and network transfer. • Call Routing applications, including Cisco’s Intelligent Contact Manager (ICM), Voice Management, General familiarity with Microsoft Windows and LINUX/ Solaris, Cisco IOS (CIOS) • Familiarity with relational database systems, including forms-based query and data entry; SQL. • Ability to translate complex contact center business requirements into call routing designs. • Ability to program, test, and implement call routing designs. • Understanding and mastery of contact center related terminology, Key Performance Indicators (KPIs), and database items and calculations. • Ability to design highly available / fault tolerant systems for mission critical voice applications. • Mastery of assisting customers in process development for managing the system in ongoing operations mode, including system administration and backup, asset management, and scheduled maintenance. • Ensure changes to design and implementation of infrastructure solutions are capable of adapting to the growth and rapid change inherent at CareSource. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=471273&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=471273&B_ID=20&fid=1 Fri, 21 May 2010 00:00:00 GMT Actively oversee the performance of the case management department to ensure all state requirements are achieved. Constantly monitor staff performance for quality measures, workloads and productivity outcomes. https://www.appone.com/MainInfoReq.asp?R_ID=474948&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=474948&B_ID=20&fid=1 Mon, 26 Apr 2010 00:00:00 GMT Job Summary: A Customer Service Representative III acts as subject matter expert, while staffing the assist line and accurately responding to inquires presented by a CSR I and II who is servicing Medicaid/Medicare member or provider, including members and providers associated with future lines of business. The CSR III also monitors queue performance, makes necessary staffing adjustments to the queues during peak periods, tracks call trends, and alerts management when necessary. Essential Functions: • Monitor and manage call queues to ensure all Customer Service Representatives are available and appropriately staffed. • Act as a “New Hire Coach” for new employees. • Maintain Outage log and report to management team weekly. • Provide Peer to Peer feedback (daily phone interaction). • Identify training needs for Service Center Representatives. • Manage and process internal route boxes. • Ability to service both member and provider calls in all lines of business, existing and future. • Utilize self-education opportunities to stay abreast of procedural updates – maintain Subject Matter Expert (SME) status in all skill sets. • Act as a mentor to new hire employees. • Answer second level assist questions. • Willingness and ability to assist Customer Service Representatives with questions and inquires. • Document all second level support questions by utilizing and maintaining the Assist Line Tracking Database. • Handle and resolve escalated member and provider complaints. • Act as a role model to other Customer Service Representatives and employees. • Display a positive attitude. • Be helpful and approachable to other Customer Service Representatives and employees. • Be accountable for actions. • Motivate other Customer Service Representatives and employees. • Assist members with routine servicing inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquires, member complaints, identifying and filing member grievances. • Assist providers with routine servicing inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures. • Ensuring all HIPAA and State requirements/regulations are adhered too at all times in existing and future lines of business. • Research, follow up and resolve all open/pending issues in a timely manner to ensure member satisfaction. • Build and strengthen member relationships by providing quality customer service. • Maintain knowledge and understanding of all processes and procedures. • Adhere to all policies and procedures. • Maintain complete and accurate documentation of all of telephone and written communications. • Screen members to determine if they need Case Management and refer when appropriate. • Route calls to appropriate departments including Pharmacy, and Triage, for proper/ex https://www.appone.com/MainInfoReq.asp?R_ID=473807&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=473807&B_ID=20&fid=1 Fri, 23 Apr 2010 00:00:00 GMT Job Summary: The Community Sales and Marketing Representative will drive and achieve health plan enrollment/growth goals by managing business/community relationships for both the Medicare and Medicaid product lines within an assigned territory and consistent with state and federal regulations for both programs. Essential Functions: • The Community Sales and Marketing Representative is responsible for educating eligible consumers and the community about the CareSource Medicare/Medicaid product lines; generating enrollment leads and referrals; supporting enrollment of Medicare eligible consumers into the CareSource Medicare Advantage plan; facilitating enrollment growth in the Medicaid product; and managing CareSource’s engagement with community stakeholders and organizations focused on services to a shared client base. • Work under the direction of the Director of Marketing/Sales to drive and achieve marketing goals by leading or advancing the marketing cycle. • Contribute to the development of a viable marketing plan for the designated territory. • Serve as a subject matter expect on CareSource Medicaid/Medicare plans and product lines. • Serve as a liaison for the health plan in designated communities via community/individual education opportunities. • Develop new forums to market and educate eligible consumers and the community about CareSource products. • Conduct presentations, marketing activities and other informational events in accordance with current approved communication and marketing programs and state/federal regulations. • Participate in planning and implementation of community outreach strategies and programs in conjunction with Quality Improvement and Provider Relations staff. • Travel throughout region to provide education about the organization to promote enrollment. • Execute basic administrative duties as defined by the Director of Marketing/Sales, including updates and maintenance of appropriate reporting/database systems (funnel management, customer information, territory planning, etc.) • Maintain working knowledge of plan benefit, program changes and industry insights. • Ensure compliance and quality of marketing and outreach process components, adhering to all applicable state and federal regulatory requirements. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=461535&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=461535&B_ID=20&fid=1 Fri, 23 Apr 2010 00:00:00 GMT Job Summary: Analyze new and existing computer systems to determine the effectiveness of their processing methods and procedures. Recommends implementation, enhancements, and operational policy guidelines as appropriate. Essential Functions: • Design, implement, and normalize DBA structures • Defines, creates, organizes, maintains logical, physical, and production DBA’s to include physical changes. • Prepare test data and tests program performance necessary to determine that program/system performs according to design specifications and end use requirements. • Develops and maintains system end user documentation necessary to ensure effective end user operations and IT support. 1. Establishes and maintains data security, including data backup/recovery and disaster planning. • Assigns user access levels as authorized by Senior Management. • Develop logical data models and program interfaces for applications systems. • Ensures that adequate and appropriate security features are installed in all Client computer systems necessary to protect the information resources of the Client from inappropriate access and dissemination. 2. Lead service support activities and initiatives • Initiate and lead support activities including problem analysis, technical evaluation, work estimates, and implementation services. • Coordinate support or project activities with all applicable constituents including customers using the systems, IT staff supporting the systems, vendors/third parties, and/or business managers. • Identify and lead, as assigned, resources and communications to facilitate work completion. 3. Provide technical guidance, training, and work direction to less experienced system engineers • Demonstrate technical proficiency in development and implementation of medium and complex systems and/or computing infrastructure through ability to guide others. • Strong learning competency and ability to teach others. • Advanced troubleshooting and problem solving capabilities 4. Assist other IT team members in understanding policies, operating procedures, and responsibilities • Mentor and train new IT team members to assist them in orientation to policies, procedures, and responsibilities. • Provide ongoing mentorship and support for questions, problems, and ideas. • Serve as an escalation point for system engineers to escalate problems and inquiries requiring further evaluation beyond the associated skill level. 5. Establish and maintain professional working relationships between IT and its customers and constituents. • Represent IT in project and/or business meeting and engagements. • Lead conference calls or visits with vendors/third parties. • Introduce new customers to IT services to assist in familiarizing them with appropriate systems, services, policies, and procedures. https://www.appone.com/MainInfoReq.asp?R_ID=466572&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=466572&B_ID=20&fid=1 Thu, 08 Apr 2010 00:00:00 GMT Job Summary: This position will work with team members, developers and department managers to develop, maintain, implement and execute a quality assurance process. The role is responsible to develop routine tests, and coordinate the testing efforts for all assigned applications and code base. Essential Functions: • Complete business analysis • Manage the requirements gathering process • Obtain and document business and system requirements • Document workflows • Provide requirements to development teams and participate in collaborative design sessions • Create and document test cases for all documented requirements • Manage and execute testing for all test cases: types include integration, certification, user acceptance, system, regression, and load tests. • Monitor, measure, and report metrics based on the results of all tests • Measure, Evaluate and test new or modified software programs and software development procedures used to verify that programs function according to user requirements and conform to established guidelines • Write, revise, and verify quality standards and test procedures for program design and product evaluation in order to economically and efficiently attain a high quality of software • Follow established quality assurance practices • Follow defined quality methods • Abide by quality controls and documentation procedures • Develop and maintain test plans, manual and automated test scripts for user interface, functionality, system and "ad-hoc testing" • Execute regression tests, functional tests and data tests • Report, track and determine priority of reported bugs promoting quality achievement and performance improvement • Maintain awareness of the business context of software • Ensure compliance with local, state, national and international standards and legislation • Define quality procedures in conjunction with operating staff • Collate and analyze performance data and charts against defined parameters • Ensure tests and procedures are properly understood, carried out and evaluated and that product modifications are investigated if necessary • Write technical and management systems reports • Monitor performance by gathering relevant data and producing statistical reports • Conduct tests on computer software programs to make sure the programs perform properly and are easy to use • Complete tests to determine weaknesses in software code • Review new or modified software, including documentation, diagram, and flow chart, to determine if a program will perform according to user requests and standards and conform to guidelines • Recommend program improvements or corrections to programmers • Identify program processing errors • Implement automated test programs to ascertain the validity of results, accuracy, reliability, and conformance to established standards • Identify differences between established standards and user applications and suggest modifications to conform to standards https://www.appone.com/MainInfoReq.asp?R_ID=470161&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=470161&B_ID=20&fid=1 Thu, 01 Apr 2010 00:00:00 GMT Essential Functions: 1. Lead development projects from inception/design through implementation. • Coordinate vendor relationships and commitments on project involvement/deliverables. • Design and implement systematic approaches and alternatives 2. Identify and document business requirements for new development projects and prepare detailed technical specifications from which programs or infrastructure can be built. • Conduct preliminary studies to define needs and determine feasibility • Confer with clients and analyze business/functional requirements • Develop procedures for moving program changes, enhancements, etc. into IT production processing. • Understand and relate business/functional requirements to application/infrastructure requirements. 3. Lead service support activities and initiatives • Initiate and lead support activities including problem analysis, technical evaluation, work estimates, and implementation services. • Coordinate support or project activities with all applicable constituents including customers using the systems, IT staff supporting the systems, vendors/third parties, and/or business managers. • Identify and lead, as assigned, resources and communications to facilitate work completion. 4. Provide technical guidance, training, and work direction to less experienced system engineers • Demonstrate technical proficiency in development and implementation of medium and complex systems and/or computing infrastructure through ability to guide others. • Strong learning competency and ability to teach others. • Advanced troubleshooting and problem solving capabilities 5. Assist other IT team members in understanding policies, operating procedures, and responsibilities • Mentor and train new IT team members to assist them in orientation to policies, procedures, and responsibilities. • Provide ongoing mentorship and support for questions, problems, and ideas. • Serve as an escalation point for system engineers to escalate problems and inquiries requiring further evaluation beyond the associated skill level. 6. Establish and maintain professional working relationships between IT and its customers and constituents. • Represent IT in project and/or business meeting and engagements. • Lead conference calls or visits with vendors/third parties. • Introduce new customers to IT services to assist in familiarizing them with appropriate systems, services, policies, and procedures. https://www.appone.com/MainInfoReq.asp?R_ID=470162&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=470162&B_ID=20&fid=1 Thu, 01 Apr 2010 00:00:00 GMT Job Summary: Works closely with customers, business analysts, and team members to understand business requirements that drive the analysis and design of quality technical solutions. These solutions must be aligned with business and IT strategies and comply with the organization’s architectural standards. Involved in the full systems life cycle and is responsible for designing, coding, testing, implementing, maintaining and supporting application software that is delivered on time and within budget. Makes recommendations towards the development of new code or reuse of existing code. Responsibilities may also include participation in component and data architecture design, performance monitoring, product evaluation and buy vs. build recommendations. Has experience in systems analysis, design and a solid understanding of development, quality assurance and integration methodologies. Essential Functions: • Defines architecture and design for enterprise applications. o Analyzes assigned specifications, planning, designing, and develops solutions, utilizing appropriate architecture processes. o Provides appropriate documentation for application design decisions, estimates assumptions and performance metrics. • Responsible for analysis and design of quality technical solutions o Analyzes, designs and builds component-based applications o Support systematic approaches to application integration. o Works on new and existing applications along with enhancements. o Performs hands-on coding, mentors junior developers and assists in architecting enterprise applications. o Serves as liaison to internal customers, research groups and various business support areas. • Lead projects from inception/design through implementation. o Solid project planning and management capabilities o Effective technical programming, analysis, and specification skills o Management skills in organizing and directing people and projects o Process and/or workflow planning and design skills • Lead service support activities and initiatives o Initiate and lead support activities including problem analysis, technical evaluation, work estimates, and implementation services. o Coordinate support or project activities with all applicable constituents including customers using the systems, IT staff supporting the systems, vendors/third parties, and/or business managers. o Identify and lead, as assigned, resources and communications to facilitate work completion. • Provide technical guidance, training, and work direction to less experienced system engineers o Demonstrate technical proficiency in development and implementation of medium and complex systems and/or computing infrastructure through ability to guide others. o Strong learning competency and ability to teach others. o Advanced troubleshooting and problem solving capabilities • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=470160&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=470160&B_ID=20&fid=1 Thu, 01 Apr 2010 00:00:00 GMT Job Summary: Provide leadership and direction for Statewide provider and ancillary contracting to facilitate optimal member access, successful business growth initiative and sound plan financial performance as it relates to unit pricing. Essential Functions: • Effectively manage day-to-day operations of the Contractors including but not limited to monthly co-visits for a full day and post visit mentoring to improve level of communication and service delivered • Travel within State a minimum of 75% of time and out of State if recruitment needs dictate • Implement Contracting Strategy and program and monitor key metrics for access and staff performance to ensure a high level of network adequacy, professionalism and staff performance • Responsible for execution from recruitment through provider onboarding to include new provider orientation • Function as a working manager, responsible for recruitment and contracting • Maintain high service levels of providers directly assigned • Support External Relations team as necessary when service needs dictate • Develop training, evaluation and development of Contractors and individual goals and accountabilities. • Participate in key corporate committees, subcommittees or workgroups as assigned • Develop market strategies related to Network Development by working closely with Marketing Department. This responsibility includes understanding, gathering and utilizing market intelligence data as it applies to Network Development. • Ensure network complies with all regulatory requirements as well as with all company-mandated policies and procedures. • Ensure that the appropriate policies, procedures and provider relations functions are in place to support the accreditation, HEDIS and audit processes. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=460590&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=460590&B_ID=20&fid=1 Tue, 30 Mar 2010 00:00:00 GMT Job Summary: Responsible for directing Project Office team members and the various functions of the team. Collaborate with various business customers to establish, implement, develop, and control best practices for project management throughout the organization. Provide executive management with dashboard view of programs and projects that are in the company strategy portfolios. Use professional concepts and knowledge of industry best practices to manage strategic projects from concept through implementation. Essential Functions: • Responsible for the successful delivery of all projects contained in the project portfolio while meeting the strategic business requirements • Drives the process of setting expectations with business owners and assists the entire organization in establishing project priorities for the strategic portfolios • Responsible for working with multiple business owners to develop solution options to determine the feasibility of projects during the initiation phase • Direct and coordinate activities of project personnel to ensure project progresses on schedule and within budget • Review status reports prepared by project personnel, and modify schedules or plans as required • Establish standards and procedures for project reporting and documentation • Portfolios and contents are periodically reviewed and assessed for linkage, support and contribution to major goals and strategies; these assessment results are communicated to executives for understanding and needed action • Information and reports are provided to governance roles and functions on a scheduled basis about initiatives and portfolios; and questions, requests for information and discussions flow in both directions between the portfolio management function and the other governance entities https://www.appone.com/MainInfoReq.asp?R_ID=466521&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=466521&B_ID=20&fid=1 Thu, 25 Mar 2010 00:00:00 GMT Job Summary: Responsible for knowledge of Facets and how that relates to each business area. Provider oversight of system configuration and perform review of setup upon completion. Manage tickets assignment, audit activities and Reimbursement and Benefit activities. Implement opportunities for process improvement that impact operations performance, quality, and/or profit. Ensure appropriate approvals, testing and controls are in place for all changes. Essential Functions: • Prioritize all work/request/activities. Escalate to management areas of significant resource contention along with recommendations for resolutions. • Track issues and their status to ensure proper follow-up and coordination of issues with business area. • Manage, organize and analyze data for presentation and approval to Reimbursement & Benefit committee. Maintain project plans/timelines and follow up with responsible parties to ensure appropriate implementation. • Conduct analysis, which compile information from various sources for members, claims and providers in support of Operation activities. • Audit and Manage system configuration of benefits/reimbursement and system configuration to ensure accuracy and internal controls are in place to minimize potential fraud and abuse and any business issues. • Play a consultative role with business owners around benefits and reimbursement related to claims, etc. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=461030&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=461030&B_ID=20&fid=1 Wed, 03 Mar 2010 00:00:00 GMT Job Summary: Manage CareSource Advantage Sales (SNP) execution. Drive and achieve health plan Medicaid enrollment/ growth goals in Michigan, primary interface between IT and all markets for Customer Relationship Management (CRM) lead management and reporting, manage effective execution of telephonic sales activities all products/all markets. Essential Functions: Travel, primarily in the State of Michigan, is required to perform the essential functions of this job. Manage CareSource Advantage Sales execution and Medicaid enrollment growth in Michigan • Rigorous, high frequency coaching/development of Sales and Marketing Representatives in account management and prospect pipeline management environments to achieve sales and enrollment goals • Work with Provider Relations to develop marketing opportunities within health centers and physician offices • Develop new forums to market and educate potential enrollees about the benefit of enrolling in CareSource. • Maintain working knowledge of plan benefit and program changes. • Coordinate weekly and monthly schedules of regional marketing staff to assure maximum coverage of marketing venues. • Monitor the activity of Community Sales and Marketing Representatives and assist with development of new marketing venues • Provide ongoing input and feedback to staff about marketing presentation effectiveness, and sales and marketing techniques. • Perform any other job related instructions as requested, with reasonable accommodation. • Assure proper use of CRM • Develop and execute major aggregate sales opportunities for SNP facilitated by detailed project planning • Work closely with Marketing to gain support needed to assure successful sales execution plans • Responsible for managing a detailed enrollment forecasting model • Partner with Provider Relations to assure targeted SNP network growth goals are met Primary interface between IT and all markets/all products for CRM lead management and reporting. • Play a key role in the system implementation • Assist all Sales Directors/all markets to assure the system is being used effectively with a focus on proper lead management • Assure that the markets are getting and using reports appropriately to manage the business • Represent the markets with IT on any system related issues Manage all prospect telephonic activity for all markets/products • Assure proper workflows are in place, technology is used appropriately and reporting is in place to achieve results on all inbound prospect calls coming into CareSource • Build and manage the execution of outbound campaigns https://www.appone.com/MainInfoReq.asp?R_ID=461057&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=461057&B_ID=20&fid=1 Tue, 02 Mar 2010 00:00:00 GMT Job Summary: The Community Sales and Marketing Representative will drive and achieve health plan enrollment/growth goals by managing business/community relationships for both the Medicare and Medicaid product lines within an assigned territory and consistent with state and federal regulations for both programs. Territory: SW Michigan; Counties of Berrien, Van Buren, Cass Essential Functions: • The Community Sales and Marketing Representative is responsible for educating eligible consumers and the community about the CareSource Medicare/Medicaid product lines; generating enrollment leads and referrals; supporting enrollment of Medicare eligible consumers into the CareSource Medicare Advantage plan; facilitating enrollment growth in the Medicaid product; and managing CareSource’s engagement with community stakeholders and organizations focused on services to a shared client base. • Work under the direction of the Director of Marketing/Sales to drive and achieve marketing goals by leading or advancing the marketing cycle. • Contribute to the development of a viable marketing plan for the designated territory. • Serve as a subject matter expect on CareSource Medicaid/Medicare plans and product lines. • Serve as a liaison for the health plan in designated communities via community/individual education opportunities. • Develop new forums to market and educate eligible consumers and the community about CareSource products. • Conduct presentations, marketing activities and other informational events in accordance with current approved communication and marketing programs and state/federal regulations. • Participate in planning and implementation of community outreach strategies and programs in conjunction with Quality Improvement and Provider Relations staff. • Travel throughout region to provide education about the organization to promote enrollment. • Execute basic administrative duties as defined by the Director of Marketing/Sales, including updates and maintenance of appropriate reporting/database systems (funnel management, customer information, territory planning, etc.) • Maintain working knowledge of plan benefit, program changes and industry insights. • Ensure compliance and quality of marketing and outreach process components, adhering to all applicable state and federal regulatory requirements. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=461061&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=461061&B_ID=20&fid=1 Tue, 02 Mar 2010 00:00:00 GMT Job Summary: Provide leadership for a comprehensive corporate compliance program to ensure organizational compliance with federal and state regulatory and accreditation requirements to include relationship management and program advocacy with CMS and state regulatory agencies, incorporation of new requirements into plan operations and monitoring plan performance against requirements. Serve as the CareSource HIPAA Privacy Compliance Officer. Essential Functions: • Provide leadership for corporate compliance program, maintaining and implementing the corporate compliance plan. • Lead relationship management with state and federal regulators including advocacy on program requirements. • Develop and implement an annual compliance monitoring program, integrating with the overall corporate audit plan. • Coordinate organizational participation in federal and state regulatory audits and site visits. • Drive the focus and management of plan initiatives and performance monitoring to obtain success in regulatory incentive programs. • Ensure staff and leadership training on the regulatory environment, programs and requirements. • Coordinate all non-financial regulatory filings including annual required submissions and those to support new business development. • Provide support to the organization in assessing and incorporating new program requirements into operations and the oversight of delegated vendors. • Ensure a comprehensive HIPAA Privacy compliance program is in place to meet federal, state and accreditation requirements. • Support the Corporate Integrity and Compliance Committee and prepare Board of Director reports as appropriate. • Investigate reported violations of regulatory requirements and the development and enforcement of appropriate corrective actions. • Provide management and oversight of professional staff • Perform any other job related duties as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=460857&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=460857&B_ID=20&fid=1 Mon, 15 Feb 2010 00:00:00 GMT Job Summary: Lead a small team of developers to deliver enhancements to and manage defects of assigned application development. Work closely with customers, business partners, project managers, and team members to understand business requirements that drive the analysis and design of quality solutions. These solutions must be aligned with business and IT strategies and comply with the organization’s architectural standards. Involved in the full systems’ life cycle and is responsible for designing, coding, testing, implementing, maintaining and supporting application software that is delivered on time and within budget. Essential Functions: • Clarify and drive team goals on a technical level making sure that the solutions proposed and designed are in line with the department’s vision • Lead component and data architecture design, performance monitoring, product evaluation and buy vs. build recommendations • Mentor other developers • Build and drive application strategies according to depart, IT, and company strategies • Assist manager with resource planning and release planning • Review and approve designs and code • Defines architecture and design for enterprise applications o Analyzes assigned specifications, planning, designing, and develops solutions, utilizing appropriate architecture processes o Provides appropriate documentation for application design decisions, estimates assumptions and performance metrics • Responsible for analysis and design of quality technical solutions o Recommend the development of new code or reuse of existing code o Analyzes, designs and builds component-based applications o Support systematic approaches to application integration o Works on new and existing applications along with enhancements. o Performs hands-on coding, mentors junior developers and assists in architecting enterprise applications o Serves as liaison to internal customers, research groups and various business support areas • Lead projects from inception/design through implementation o Solid project planning and management capabilities o Effective technical programming, analysis, and specification skills o Management skills in organizing and directing people and projects o Process and/or workflow planning and design skills • Lead service support activities and initiatives o Initiate and lead support activities including problem analysis, technical evaluation, work estimates, and implementation services. o Coordinate support or project activities with all applicable constituents including customers using the systems, IT staff supporting the systems, vendors/third parties, and/or business managers o Identify and lead, as assigned, resources and communications to facilitate work completion • Provide technical guidance, training, and work direction to less experienced system engineers o Demonstrate technical proficiency in development and implementation of medium and complex systems and/or computing infrastructu https://www.appone.com/MainInfoReq.asp?R_ID=454712&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=454712&B_ID=20&fid=1 Fri, 29 Jan 2010 00:00:00 GMT Job Summary: Responsible for utilization review and discharge planning activities for members enrolled with a CareSource Management Group (CareSource) line of business, monitoring the appropriate delivery of health care services in a cost effective manner. Maintain knowledge of State and Federal regulations governing CareSource, State Contracts and Provider Agreement, benefits and URAC Standards. Essential Functions: • Prospective, retrospective and concurrent review of inpatient admissions, outpatient procedures, homecare services and durable medical equipment. • Coordinate care and facilitate discharge to an appropriate level of care in a timely and cost-effective manner. • Identify and refer quality issues to Quality Improvement. • Identify and refer appropriate members for Case Management. • Document and communicate with CareSource and Provider Case Managers and Discharge Planners to establish discharge planning needs and coordinate care. • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=457243&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=457243&B_ID=20&fid=1 Sun, 24 Jan 2010 00:00:00 GMT Job Summary: The Storage Architect will be responsible for the design and administration of the storage area network including: the storage arrays, the fibre channel switches, the network attached storage, and the content addressed storage. Essential Functions: • Plan, Present, Design and Architect current, interim and future Storage Technologies growth & upgrade cycles using cost effective methodologies working with multiple teams (Storage, DBA, Servers, Networks, and Applications) • Plan and maintain SAN Disaster Recovery/Business Continuity components and procedures • Work with the CIO and IT Managers to drive multiple storage projects within different time lines • Mentor Storage engineers • Perform any other job related instructions as requested, with reasonable accommodation. https://www.appone.com/MainInfoReq.asp?R_ID=453251&B_ID=20&fid=1 https://www.appone.com/MainInfoReq.asp?R_ID=453251&B_ID=20&fid=1 Thu, 21 Jan 2010 00:00:00 GMT