Employment Opportunities
LPN Nurse Case Manager
Posting #: 796
Posted: 3/18/2008
Hours: Full-time, Exempt
Summary: With minimal supervision, plan, direct, and evaluate total managed care options for members and function as part of an interdisciplinary team in accordance with established philosophy. Relate effectively with others for continuity of care; maintain satisfactory relations with others, maintain accurate and complete records, and upgrade policies, procedures, and skills of others within the department.

Responsibilities:
  • Initiate and implement a managed health care plan for the member
  • Identify problems and provides the best possible solutions
  • Accurately and promptly implements solutions
  • Relate effectively with co-workers regarding continuity of care
  • Create a working climate that provides growth and job satisfaction to others within the department
  • Participate in planning changes and improvements
  • Maintain a professional approach with the highest standard of confidentiality
  • Display concern and initiative and is able to remain calm when accepting urgent requests or phone calls from others
  • Maintain the standards of accurate and complete recording and reporting
  • Cooperate and maintain good rapport with staff, other departments, members, providers, and agencies involved in providing quality care to the member
Qualifications:
  • Licensed Practical Nurse with a valid license
  • Minimum of three to five years nursing experience
  • Ability to learn and adapt
  • Ability to direct others
  • Knowledge of Medicaid, Medicare and coding is helpful
  • Working knowledge of Microsoft Office Suite
This position offers an outstanding benefit package, including three weeks vacation the first year, a generous retirement plan, health and dental insurance (85% employer paid) and much more! If you are passionate about providing outstanding service and would like to become an integral component of our team submit your resume today to resumes@group-health.com. Group Health Cooperative is an affirmative action and equal opportunity employer
Provider Relations Representative
Posting #: 795
Posted: 3/6/2008
Hours: Full-time, Non-Exempt
Summary: As a Provider Relations Representative you will be responsible for effectively communicating with our health care providers in regards to questions on eligibility, benefits, claim status, contracts and other miscellaneous questions.

Responsibilities:
  • Respond to telephone calls, voice mails, fax requests, etc in a professional and timely manner;
  • Coordinate provider appeals;
  • Perform trending and analysis of inquiries and concerns to identify potential areas for provider education;
  • Document provider contact information into the computer system;
  • Assure that inquiries are answered in accordance with contract, policy and provider provisions;
  • Familiarity with all contract updates as they become available to assure accurate processing of inquiries;
  • Additional duties as assigned.
Qualifications:
  • High school graduate or equivalent;
  • Working knowledge of health insurance claims preferred;
  • One to three years experience in the health care or insurance industry preferred;
  • Basic proficiency in Microsoft Word and Excel;
  • Excellent customer service skills;
  • Attention to detail;
  • Ability to multi-task.
Group Health offers an exceptional compensation benefit package including three weeks of PTO the first year, health and dental insurance (85% employer paid), a generous retirement plan and more. If you would like to join a high performing organization and appreciate working in a fast paced and positive environment, please send your resume to: resumes@group-health.com Group Health Cooperative is an affirmative action and equal opportunity employer
Systems Analyst
Posting #: 793
Posted: 11/26/2007
Hours: Full-time, Exempt
Summary: The Systems Analyst will be responsible for providing technical support through installing software upgrades as well as training, planning, developing and monitoring data warehouses created with McKesson’s CRMS and other specialized IT systems. The Systems Analyst will also provide support to the HEDIS reporting team.

Responsibilities:
  • Maintain integration of data between current IT systems & CRMS
  • Maintain CRMS software including planning, implementation and maintenance of upgrades
  • Troubleshoot and resolve problems related to CRMS & HEDIS reporting
  • User training provided on any new development or system modifications
  • Other job related duties necessary to carry out the responsibilities of this position
Qualifications:
  • Bachelor’s degree in Computer Science or equivalent
  • Three to four years Systems Analyst and SQL Server experience
  • Four to six years SQL programming experience
  • Organized and attentive to detail
  • Demonstrated excellent communication skills
  • Knowledge of Microsoft Office Suite
  • Knowledge of the healthcare or insurance industry is preferred
  • Knowledge of utilization, case or disease management is preferred
This position offers an outstanding benefit package including three weeks vacation the first year, a generous retirement plan, health and dental insurance (85% employer paid) and much more! If you would like to become an intergral component of a growing company, we want you on our team! Please send your resume to resumes@group-health.com. Group Health Cooperative is an affirmative action and equal opportunity employer.