Director, Health Care Management Services

Description:JOB SUMMARY: The Director, Health Care Management Services is responsible for the development, implementation and coordination of a comprehensive health care program that will assist Health Care Management Services, Medical Management, and/or Health Plans, resulting in improved health outcomes for members. PRIMARY RESPONSIBILITIES:1. Assists in development and implementation of clinical programs in accordance with the goals of AMERIGROUP Corporations mission, vision and values, the needs of the health plans, federal and state regulatory requirements and NCQA standards.2. Serves as a clinical leader to HCMS / Medical Management associates.3. Manages and evaluates teams performance and ensures adherence to departments standards. 4. Provides departments with updates as needed to ensure continued compliance with specific medical management standards5. Assists in the development of medical management policy, procedures and guidelines that relate to specific programs. 6. Assists in evaluating and implementing contracts in coordination with Network Development as needed to implement specific programs.7. Assists Member Services and Provider Inquiry Department with timely response to issues including complaint resolution.8. Assists in developing clinical management guidelines including:- Conducting literature search to identify "evidenced-based" management - Identifying changes in practice which may require updating of guidelines- Developing DRAFT guidelines as directed - Identifying national providers experienced in treating patients within these areas - Coordinating physician advisory groups9. Assists in managing the information requirements of HCMS / Medical Management programs. 10. Acquires data and evaluates necessary medical, mental health and substance abuse services for cost containment. 11. Identification and implementation of HCMS/ Medical Management "best practices." 12. Ensures that delegated medical management activities are contracted, reviewed and reported according to established criteria. 13. Evaluates programs quarterly. 14. Supports and participates in quality initiatives and activities including clinical indicators reporting, focus studies and HEDIS reporting. 15. Ensures compliance with state reporting on utilization management activities for accuracy. 16. May assist in developing the annual operating and capital budgets to sufficiently meet departmental needs. 17. Other duties as requested or assigned.Qualifications:EDUCATION AND EXPERIENCE:EducationRequired: Bachelors Degree, or equivalent work experiencePreferred: MSN, MPH, MPA, or MSW or related or MBA with Health Care ConcentrationYears and Type of Experience Required: - Must have five years management experience.- Must have at least five years of current experience in utilization management in a managed care setting. Knowledge and Technical SkillsRequired: - Demonstrated medical management experience in health care.- Knowledge of Utilization Management targets- Self-directed with strong organizational skills.- Excellent verbal and written communication skills.- Ability to foster inter and intradepartmental communication and team building.- Strong analytical capabilities.- Attention to detail.- Mastery of computer software.- Statistical reporting experience preferred.- Multi-task oriented with ability to follow-up on numerous complex problems.- Strong customer focus.Certifications or LicensureRequired: RN or LCSW, LPCPreferred: Certified Case Manager SCOPE INFORMATION - Direct Reports 2-10- Indirect Reports 2-20- Budgetary Responsibility as assignedPHYSICAL REQUIREMENTS- Able to operate a computer- Able to operate a telephone- Must be able to travel on common carriers and to adhere to AMERIGROUPs travel policies.Salary/Benefits: Salary commensurate with experienceAMERIGROUP Associates help make a difference in the hundreds of lives they touch every day. We understand that many of our members are moms and kids who depend on us to help them get the health care their family needs. If you share our commitment to improving people's lives, AMERIGROUP may have a place for you. AMERIGROUP Corporation is committed to associate career development and growth, providing opportunities in a culturally diverse, energetic environment. We take pride in offering extensive training programs, competitive compensation, incentives and excellent benefits including:* Relocation Assistance* Paid Accumulated Leave* Holidays* Medical Insurance* Dental Insurance* Life Insurance* Short-Term Disability* Long-Term Disability* 401(k)* Employee Stock Purchase Plan* Flexible Spending Accounts* Employee Assistance Program* Company Sponsored Training* Departmental Incentives* Continued Career Growth and Development OpportunitiesJob Location: Atlanta, GAJob Number: 8907Company URL: http://www.amerigroup.jobsCompany Profile:AMERIGROUP Corporation (NYSE: AGP), headquartered in Virginia Beach, VA, is a multi-state managed health care company focused on serving people who receive health care benefits through state-sponsored programs. From Medicaid, Temporary Assistance for Needy Families (TANF) and State Children's Health Insurance Programs (SCHIP) to Supplemental Security Income (SSI), Long Term Care and Medicare coverage, they help people of all ages get the care they need and the respect they deserve. Through its many AMERIGROUP Community Care subsidiaries, they currently help more than 1.7 million low-income Americans throughout the nation. The company operates in Florida, Georgia, Maryland, New Jersey, New York, Ohio, South Carolina, Tennessee, Texas, Virginia and the District of Columbia.In 1994, AMERIGROUP was founded to respond to the growing need for private-sector partners in state managed health care programs for lower-income families and people with disabilities. Since its inception, AMERIGROUP has been a proven leader in meeting the states' objectives of providing accountability and improving access to health care while still controlling care costs. Today, AMERIGROUP is the largest corporation focused exclusively on the health care needs of Medicaid recipients and the uninsured.Our mission is to operate a community-focused managed care company with an emphasis on the public sector health care market. We will coordinate our members' physical and behavioral health care, offering a continuum of education, access, care, and outcome, resulting in lower costs, improved quality and better health status for Americans.If you share our commitment to improving people's lives, AMERIGROUP may have a place for you. We're growing dramatically and would like you to consider working for a leader in the healthcare industry. AMERIGROUP is committed to associate career development and growth, providing unlimited opportunities in a culturally diverse, energetic environment.