| Do you want to work for a progressive company and enjoy a competitive salary and excellent benefits? If this sounds like a company you’d be interested in working for, send us your cover letter letting us know which opening you’re applying for and include an updated resume. We’re happy to accept your information in any of the following methods.
Mail: Health New England, Human Resources, One Monarch Place, Suite 1500, Springfield, MA 01144-1500
Fax: (413) 233-2747
E-mail: humanresources@hne.com
For more details on the openings that interest you, please check below.
Behavioral Health Specialist
Communications Coordinator
Director of Health Services
Medicare Compliance Administrator
Medical Director
Underwriting Technician
Behavioral Health Specialist
Position Summary:
Perform case management and utilization management functions for fully funded and self-funded members. Complete assessments and develop and implement care plans for assigned members according to department policies and procedures. Conduct inpatient and outpatient admission, concurrent, and discharge reviews. Review medical necessity denials with the plan Physician reviewers.
Qualifications:
- Master's Degree in clinical Psychology or Social Work required or BS in Nursing with psychiatric experience
- Licensure as a psychologist, social worker, allied mental health professional, or registered nurse
- Minimum of 3-5 years experience in behavioral health services that must include inpatient, ambulatory, and/or case management, emergency psychiatric services and diversionary levels of care
Additional skills include:
- Familiarity with the most current edition of the Diagnostic & Statistical Manual of Mental Health Disorders of the American Psychiatric Association
- Familiarity with medications specific to behavioral health populations
- Familiarity with regional behavioral health treatment resources
- Ability to conduct multiple tasks under stringent regulatory deadlines with attention to detail
- Excellent verbal and written communication skills
- Ability to maintain strict confidentiality
- Some skills utilizing behavioral health or related software
We are committed to the people we serve, our providers and our community.
For consideration, please e-mail your resume and Curriculum Vitae to: humanresources@hne.com or mail to: Human Resources, Health New England, One Monarch Place, Suite 1500, Springfield, MA 01144-1500, fax: (413) 731-5275.
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Director of Health Services
Position Summary:
The Director of Health Services is responsible for the directing, leading, developing, implementing Case Management (CM), Disease Management (DM) and Utilization Management (UM) programs to ensures that HNE members receive coordinated, high quality, cost effective care. Identifies areas that may need improvement and initiates change, while managing the budget for the HS staff.
Qualifications:
- Current Licensure: RN licensure with BA, BS or BSN. Master's degree in Nursing, Health Administration, Business Administration or Science highly preferred.
- Seven to 10 years experience in health care, preferably in a managed care payor environment
- At least five (5) years of management experience
- At least three (3) years of managing utilization, case and disease management activities
- Strong knowledge and experience with state licensure, regulatory requirements and NCQA accreditation process
Additional skills include:
- Knowledge of data collection, analysis and data presentation methods
- Ability to function independently to establish own and departments work plans and priorities to meet organization goals.
- Ability to adjust to multiple demands & shifting priorities
- Computer literate, particularly in Windows based applications (Word, Excel, Power Point, Access)
- Excellent verbal, written and presentation skills
- Project management experience
- Problem resolution skills
- Demonstrated management & negotiation experience
We are committed to the people we serve, our providers and our community.
For consideration, please e-mail your resume and Curriculum Vitae to: humanresources@hne.com or mail to: Human Resources, Health New England, One Monarch Place, Suite 1500, Springfield, MA 01144-1500, fax: (413) 731-5275.
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Medicare Compliance Administrator
Position Summary:
Determine how Medicare legal rules affect HNE's business & policies, and assist team in formulating sound business practices that meet Medicare requirements as well as business needs. Take overall responsibility for the HNE Medicare Compliance Program. Actively participate on numerous committees and projects within HNE. Identifies areas that may need improvement and initiates change.
Qualifications:
Bachelor's Degree in Business, Healthcare Administration or related field; with a minimum of three years experience in health care compliance with an emphasis on Medicare compliance; or an equivalent combination of education and experience.
Additional skills include:
- Knowledge of managed care, health care, and Medicare regulatory requirements
- Ability to apply legal/compliance rules to practical daily operations
- Ability to read and understand the meaning and significance of Medicare laws, regulations and regulatory manuals, guidance, and materials
- Ability to advocate to senior management and others for compliance-related needs
- Understanding of HMO business practices and HNE Medicare products
- Ability to represent HNE in a positive and professional manner to both internal and external customers
- Ability to present an unpopular opinion
- Ability to prioritize assignments, be flexible, and assess risks to focus resources on appropriate goals
- Highly effective research, writing, and communication skills
- Excellent word processing skills and Excel knowledge very desirable
We are committed to the people we serve, our providers and our community.
For consideration, please e-mail your resume and Curriculum Vitae to: humanresources@hne.com or mail to: Human Resources, Health New England, One Monarch Place, Suite 1500, Springfield, MA 01144-1500, fax: (413) 731-5275.
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Medical Director
Position Summary:
The Medical Director will have responsibility for utilization management and quality improvement for the delivery system. Other responsibilities include working with physicians to improve performance and utilization. The Medical Director also participates in physician recruitment, peer activity, credentialing, clinical advisory healthcare teams, and utilization review. The Medical Director shall function as a consultant representing the medical department to internal and external customers, including providers, employers and brokers.
Qualifications:
The successful candidate will have:
- A Medical Degree with board certification, holding an active, unrestricted license to practice, with a minimum of 5 years post-residency clinical/direct patient care experience
- Advanced Management Training
- Practical experience in health care administration and managed care experience desirable
Additional skills include:
- Demonstrated knowledge of the regulatory environment of managed care
- Excellent clinical, analytical, and facilitation and negotiation skills
- Must show evidence of leadership skills and possess excellent interpersonal skills required to interact with associates and customers.
- Able to exercise good judgment in problem solving and decision-making situations
- Excellent presentation, oral and written communication skills
We are committed to the people we serve, our providers and our community.
For consideration, please e-mail your resume and Curriculum Vitae to: humanresources@hne.com or mail to: Human Resources, Health New England, One Monarch Place, Suite 1500, Springfield, MA 01144-1500, fax: (413) 731-5275.
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Communications Coordinator
Position Summary:
The Communications Coordinator determines whether proposed benefit and plan changes are consistent with operational practices, identifies particular problems, and reports them to the Communications Manager. Responsibilities include preparation and distribution of communications materials in a manner consistent with regulatory and accreditation requirements and customer expectations.
Qualifications:
The successful candidate will have:
We are committed to the people we serve, our providers and our community.
For consideration, please e-mail your resume and Curriculum Vitae to: humanresources@hne.com or mail to: Human Resources, Health New England, One Monarch Place, Suite 1500, Springfield, MA 01144-1500, fax: (413) 731-5275.
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Underwriting Technician
Position Summary:
The primary purpose of this position is to process renewals, new quotes, newly sold business, and terminations in an accurate and timely fashion. This position works within the confines of set business rules.
Qualifications:
- High school diploma plus two to three years experience in the insurance industry.
- Strong mathematical and financial skills
- Strong attention to detail
- Excellent computer skills -- Microsoft Office Suite required; database experience preferred
- Excellent verbal and written communication skills
- Knowledge of managed care products preferred
We are committed to the people we serve, our providers and our community.
For consideration, please e-mail your resume and Curriculum Vitae to: humanresources@hne.com or mail to: Human Resources, Health New England, One Monarch Place, Suite 1500, Springfield, MA 01144-1500, fax: (413) 731-5275.
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