Member Services Director jobs in Fort Smith, AR

SCOPE OF POSITION:
Responsible for the efficient and effective development, production, and management of all aspects of AFMC’s clinical case review in Medicare, Medicaid, and private review contracts as well as referrals by outside agencies. Develop relationships and promotes mutually beneficial partnerships with clients, key stakeholders, constituents, provider groups, other healthcare organizations and the community at large. Market the programs and services of AFMC to existing and new stakeholders. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence Accountability, Respect and Teamwork.

ESSENTIAL JOB FUNCTIONS:

KNOWLEDGE, SKILLS, AND ABILITIES:

• Intermediate skill level with MS Office (Word, Excel, Outlook, PowerPoint).
• Type 40 wpm.
• Exceptional skills in business English and spelling are required.
• Good command of the English language and knowledge of punctuation, grammar, and spelling are required.
• Knowledge of regulations and contract requirements pertaining to the assigned area of responsibility.
• Ability to lead and participate in multi-disciplinary team projects involving professional personnel from several fields.
• Ability to manage and direct the work of outside consultants, outsourced services and other external entities.
• Well-developed planning, marketing, organizational development, and business skills.
• Ability to build and manage partnerships and relationships with a variety of stakeholders required.
• Strong detail orientation, organizational and project management skills evidencing an ability to respond to multiple projects simultaneously with appropriate sensitivity and tact including the ability to manage through conflict.
• Ability to negotiate both financially and conceptually and reach mutually agreeable solutions.
• Advanced financial analysis skills.
• Ability to maintain confidentiality.
• Coaching skills.
• Creativity.
• Customer service.
• Ability to delegate as required.
• Ability to meet deadlines.
• Flexibility.
• Ability to work collaboratively and independently to achieve stated goals.
• Initiative.
• Ability to relate professionally and positively with staff, business partners, customers, constituents, recipients, and the public.
• Knowledge of ICD 9/ICD 10 Coding.
• Knowledge of HIT/HER.
• Medical terminology.
• Leadership skills.
• Ability to prioritize.
• Problem solving skills.
• Professionalism.
• Strong public speaking skills.
• Ability to travel, including overnight travel.
• Time management skills.
  

Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices):
Mobility, reaching, bending, lifting, grasping, ability to read and write ability to communicate with personnel and ability to remain calm under stress. Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.

EDUCATION:
Required: Bachelor’s degree in nursing and currently licensed as a Registered Nurse in the state of Arkansas, without restrictions.

Desirable: Master’s degree in nursing, public health, healthcare administration, business administration or statistics

EXPERIENCE:
Required: Six (6) years’ experience in nursing, Four (4) years leadership experience. Five (5) years utilization review, quality assurance, coding or RHIT/RHIA hospital experience, experience and knowledge of Medicare, Medicaid, and other major managed healthcare programs

Desirable: Experience in a QIO, non-profit and/or professional services healthcare setting

INTERNET REQUIREMENTS:
Reliable, high-speed wireless internet service (Wi-Fi)