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.

Case Manager

Large Group Sales Executive

Medical Director

Provider Claims Representative

Provider Contracting Specialist

Provider Relations Representative

Case Manager

Position Summary:
The Case Manager will deliver utilization management (UM), case management (CM) and disease management (DM) services to members in compliance with current accreditation requirements and quality standards, and within the scope of the members' benefit package and per HNE UM, CM, and DM policies.  Support the HNE mission by developing partnerships with and providing personal and accountable service to members and providers.  Impact positive health outcomes for members and positive financial outcomes for HNE. 

Qualifications:
The successful candidate will have:

• RN with a current Massachusetts license
• 3-5 years experience required
• BSN preferred; CMM preferred

Additional skills include:

• Experience as a case/care manager, utilization management nurse, or health coach in managed care, home care, or hospital setting preferred
• Knowledge of chronic health conditions preferred
• Experience in patient education working with individual patients required
• Excellent written and verbal communication skills including a willingness to deliver presentations
• Sound clinical assessment and decision making 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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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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Provider Claims Representative

Position Summary:
The Provider Claims Representative acts as HNE's Claims Department's liaison to our provider community.  This individual interacts with provider offices regarding claims status, claims history, and verification of adjudication in a professional and courteous manner. 

Qualifications:
The successful candidate will have:

• High school diploma
• Minimum of 3-5 years experience adjudicating health insurance claims, including good knowledge of relevant insurance policies, procedures, guidelines, and insurance eligibility determination
• Knowledge of applicable federal and state laws, regulations, and requirements or an equivalent combination of education and experience

Additional skills include:

• Excellent analytical, research, and problem resolution skills
• Excellent interpersonal and 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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Provider Contracting Specialist

Position Summary:
Responsible for contract negotiation, implementation and maintenance of the ancillary provider/facility network and the independent physician network.  Assists the Provider Contracting Department with activities related to the evaluation, implementation and maintenance of other provider contracts as necessary. Assesses financial impacts of new provider contracts and changes to existing provider contracts.  Assists with special projects as necessary.

Qualifications:
The successful candidate will have:

• *  Bachelor's degree with more than 2 years experience in a managed care environment; clinical experience a plus or an equivalent combination of education and experience

  *  Knowledge of provider contracting models and arrangements

  *  Good knowledge of managed care products, policies and procedures

  *  Effective communication and presentation skills

  *  Strong computer skills including Microsoft Word, Excel, Powerpoint, Access, Amisys

  *  Initiative, excellent judgment and superior problem solving skills

  *  Strong customer orientation and ability to manage expectations and needs of all customers

  *  Ability to balance multiple priorities

  *  Represent HNE and its initiatives in a positive and professional manner

  *  Ability to maintain poise, composure and diplomacy in negotiations and when under pressure or challenged

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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Provider Relations Representative

Position Summary:

This position serves as the primary liaison to HNE’s provider network, providing information and training on new products & initiatives; ensuring provider compliance with regulatory requirements and HNE contractual obligations; and responding to and resolving provider issues, questions and concerns.  Ensuring providers have accurate and up-to-date information, and addressing their issues and concerns in a timely manner, has an impact on providers’ decisions to join or remain part of HNE’s provider network.

Qualifications:

• Associate's Degree in Business or a HealthCare related field and 3-5 five years experience in a managed care or other insurance environment or an equivalent combination of education and experience.
• Strong understanding of managed care, high deductible, indemnity and regulated market products
• Ability to analyze and interpret data
• Strong presentation skills - ability to respond to questions on the spot and remain poised under pressure
• Strong verbal and written communication skills
• Excellent customer service skills
• Solid understanding of HEDIS and NCQA standards
• Proficient with Microsoft Office Suite (Word, Excel and Access)

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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Large Group Sales Executive

Position Summary:

Responsible for prospecting and generating sales of national, regional and other large self-insured and fully-insured accounts. This position will sell to companies and organizations whose sizes have the potential to create more than 500 new subscribers to HNE health plans upon the closure of each sale. This will require developing relationships with prospective clients over long periods of time. The incumbent will be responsible for achieving sales objectives for assigned large group prospects. Works closely with the sales manager to develop and implement sales strategies to achieve sales growth of target market.

Qualifications:

A Bachelor's degree plus a minimum of 5 years professional business experience in Sales/Marketing. Healthcare sales and or consulting experience required or an equivalent combination of education and experience.

• Experience in employer stop loss and self insurance
• Excellent interpersonal, communication and negotiation skills, including well-honed public speaking, presentation and influencing skills
• Ability to present to key decision making executives of clients and their consultants
• Ability to work independently with a strong results orientation
• Demonstrated proficiency in sales process and prospecting skills, ability to develop new prospects
• Can identify and clarify customer needs to develop solution
• Demonstrated proficiency of benefit plan design, underwriting, financial principles and processes
• Strong customer service focus
• Excellent interpersonal and problem solving skills
• Excellent organizational skills
• Familiarity with Microsoft Office Suite
• Valid driver’s license and a personal vehicle
• Massachusetts Life & Health Producers License (or ability to be licensed)

Position requires use of a personal automobile for traveling on a regular basis to clients. Travel to client corporate headquarters may be required. Meetings, presentations and health fairs may be scheduled beyond core business hours so flexibility of workday hours is required.

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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