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Career Opportunities
Job Title: Nurse Supervisor, Medical Resource Management
Organization/Company: Physicians Health Plan
Description: The Medical Resource Manangement Nurse Supervisor position is responsible for leading, directing and overseeing the health plan MRM daily operations of the department. The Nurse Supervisor is responsible the supervision, research, coordination and outcome measures of unitization and case management activities within the department. This position serves as critical member of the Medical Resource Management team, collaborating and communicating with the Medical Director(s), MRM Director, MRM clinical and non clinical staff, providers and other departments within the plan to ensure the quality, efficiency of health care delivery and to promote the health and well being of the Plan members.
Bachelor's degree or equivalent education and experience required. Valid unrestricted Michigan RN license. Skills required: excellent verbal and written communication skills; excellent interpersonal skills; computer knowledge and proficiency; ability to multi-task and work under pressure with regulated timeline; critical thinking skills; ability to lead through change.
We prefer: knowledge of Milliman, Hayes, MDCH criteria, HCPCS, CPT and ICD-9 coding, and knowledge of contractual arrangements.
Application Procedure: For a full job description and to apply online: www.sparrow.org, Careers, requisition 19080, or submit resume to lesley.mozola@sparrow.org
Contact: Lesley Mozola
Date Posted (mm/dd/yyyy): 1/17/2012
Expiration Date (mm/dd/yyyy): 2/17/2012
Job Title: Manager, Managed Care Contracting
Organization/Company: Allegiance Health
Description: The Managed Care Contracting Manager reports to the Managed Care Director and is responsible for developing, managing and sustaining relationships with payors and internal customers. Conducts contract negotiation activities as needed. Reviews billing and claims payments according to managed care contracts in order to optimize collections. The manager is also responsible for providing leadership in the coordination of departmental activities and personnel matters pertaining to the employment, training, termination and grievance of employees.
Functional Responsibilities:
1. Designs, monitors and enhances organizational processes.
2. Develops and implements programs to influence behaviors, develops and maintains positive relationships.
3. Conducts negotiation activities as needed.
4. Collaborates with Departmental leaders to obtain input on managed care contracting.
5. Develops and designs tracking dashboards relative to payer activities.
6. Monitors underpayment review processes and report findings.
7. Ability to function in successfully in an extremely challenging environment.
8. Establishes a course of action for self and others to accomplish specific goals; plans proper assignments, and effective and efficient allocation of resources.
9. Actively attends Management Committee meetings.
Qualifications:
1. Bachelor Degree in Business Administration or related area.
2. Three-to five years managed care contracting experience.
3. Demonstrates leadership ability, effective verbal and written communications, and interpersonal skills necessary to interact and build strong relationships with physicians, management, staff, external agencies, customers and patients/families.
4. Proficient computer skills in word processing and spreadsheet software.
5. Strong personal initiative and analytical skills necessary for collecting, tabulating, and analyzing data to determine and implement effective action and solutions.
6. Demonstrates excellent negotiation skills and broad-scope financial expertise.
7. Demonstrates capability to prioritize multiple conflicting duties, frequent travel and an ability to adapt to diverse customer population.
8. Revenue and procedure coding experience required.
9. Ability to identify leaders and develop staff.
10. Capable of standing, walking, stooping, bending and lifting up to 25 pounds.
Working Conditions:
Works in a standard, temperature-controlled, clean office environment with occasions to use and work in the file storage areas.
Application Procedure: Please apply at: www.allegiancehealth.org
Contact: Darcey Eagen, 517-780-7322
Date Posted (mm/dd/yyyy): 1/5/12
Expiration Date (mm/dd/yyyy): 2/5/12
Job Title: Senior Sales Representative
Organization/Company: Physicians Health Plan
Description: Meets sales goals and quotas. Cold calls agents and prospects. Develops and maintains relationships with insurance agents via phone, written communication and personal visits. Presents PHP''s value proposition, including benefits, rates and delivery system to employees and/or brokers/agents. Maintains current knowledge of competitors'' benefits and rates. Prepares oral and written sales presentations and benefit comparisons. Provides new group education. Considerable driving required. 50% of time spend out of office. State of Michigan Insurance Bureau license to sell health insurance required. Minimum five years of successful new sales of health insurance and managed care products to employers, both directly and through broker/agent distribution systems. Minimum three years selling small to medium employer groups. Consistent track record of 3+ years of exceeding performance targets for positions held. Complete understanding of the indemnity business, alternative funding and experience rating. Demonstrated strong time management skills and case renewal strategic planning. Effective public speaking skills with ability to present concepts and information clearly. BA in sales, marketing, business administration or equivalent combination of education and experience.
Application Procedure: Apply online at www.sparrow.org, Careers (requisition 18896) or email resume to lesley.mozola@sparrow.org
Contact: Lesley Mozola
Date Posted (mm/dd/yyyy): 01/18/2012
Expiration Date (mm/dd/yyyy): 02/18/2012