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Nationwide Search for Director of Risk Adjustment Analytics (T-SQL) to oversee the general organization and efficient management of the Medicare Comprehensive Health Assessment Program (CHAPs) data activities for leading healthcare organization. Includes participation in ongoing data mining and analysis, oversight of, development and delivery of education and identification of opportunities to improve reimbursement through proper coding and documentation. Responsible for the ongoing....


Seeking an Executive leader committed to the medical management function, who thrives on coaching and mentoring a large organization, has a creative and visionary style of leadership with excellent communication skills Are you looking for an opportunity to shine and have ideas that can make a positive impact on programs of care management? Do you have creative ideas and want to work with a GREAT Team? The Director will work closely with the Medical Informatics team to identify trends that need


Seeking expert in Claims Configuration to Direct and oversee the claims configuration and pricing/benefits set up within the claims payment system ensuring accurate reflection of provider contracts and claims payments with large healthcare enterprise. Ensures timely and accurate configurations and pricing/benefits set up for new business implementationsEnsure changes in provider contracts are reflected in the claims payment systemCollaborate with stakeholders to gather business requirements....


Seeking an Executive leader committed to the medical management function, who thrives on coaching and mentoring a large organization, has a creative and visionary style of leadership with excellent communication skills Are you looking for an opportunity to shine and have ideas that can make a positive impact on programs of care management? Do you have creative ideas and want to work with a GREAT Team? The Director will work closely with the Medical Informatics team to identify trends that need

- St Louis, MO

Exclusive Search for Finance/Data Analyst with 6+ years complex and high-level financial analysis experience to lead various financial projects. Focus: Cost-effectively manage the utilization of services and develop measures to track, trend and forecast related impacts of organizational strategic initiatives. Run pre-established reports as well as development of new reports for internal stakeholders and regulatory agenciesDevelop metrics to evaluate financial impact of proposed contract....


Exclusive, Nationwide Search for a strong dynamic high-level nurse leader with a decade of medical management experience. This highly visible role will involve presenting to key stakeholders, coordinating with the medical management, quality improvement, and credentialing teams to support the strategies, vision, and policies of the health plan organization. Direct and coordinate activities of department and aid the chief officer of the health plan and appropriate corporate staff in formulating


Exclusive Search for Regional Medical Director to serve as liaison for the health plan. Responsibilities and focus to ensure that all the opportunities are highlighted through detailed reporting to the leadership building creditable and trusting relationships with stakeholders regarding performance metrics and serving as the clinical lead with large employer groups in the bid process. Manage assigned departments or functions with an emphasis on execution, outcomes, continual improvement and....


Job descriptionPosition Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Reports to Chief Medical Director. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental....


Job description This position reports to the Director of Provider Contracting & Network Management to support the contracting activities of the Medical Group and Health Plan. Responsibilities include managing outside medical cost through contracting initiatives, analysis of financial reports and trends in the marketplace covering IPAs, PHOs, hospitals, and key specialty services. Contractual arrangements will be complex and comprehensive, needing a depth of understanding of managed care;....


Director, Provider Payment Innovation (Provider Network Management) Fantastic opportunity to join Fortune 100 leading healthcare enterprise experiencing incredible growth and market expansion. Design, implement and optimize innovative and value-based payment contracting strategies for the health plan to include the development of a broad vision, short and long-term objectives and execution of key business initiatives across all products. Collaborate with multiple functional health plan....


Nationwide Search for Vice President, Quality & Process Improvement (Health Plan) (RN, CPHQ) Position Purpose: As the senior leader, reporting to the Chief Medical Director, you will be responsible for developing and overseeing the quality improvement functions.. To be part of the leadership team to lead and direct process improvement activities, streamline the workflow for a more efficient process. To oversee business processes related to risk adjustment and quality improvement activities

- St. Louis Area, MO

Exclusive Search for Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit as part of a team of Medical Directors assisting the Chief Medical Director of Fortune 100 healthcare enterprise. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical....


Exclusive Nationwide Search for Senior Medical Director to Assist the Chief Medical Officer (CMO) to direct and coordinate the medical affairs functions for the business enterprise. Oversee the denials and appeals department. May manage other medical directors. Medical Leadership Provide medical leadership for all utilization management, pharmacy, case management, disease management, cost containment, and medical quality improvement activities. Perform medical review activities pertaining to....

- NW, SW, Central Ohio, OH

Exclusive Search for Manager, Provider Network to Manage the day-to-day operations of the network accounts department function of this Fortune 100 healthcare enterprise to ensure compliance with health plan, corporate and state policies, procedures, and guidelines to achieve healthy outcomes. *Candidate can reside in NW, SW or Central Ohio Manage the network accounts team to ensure goals and objectives are met through effective hiring, performance management, training, coaching, and career....


Nationwide Search for Senior Director, Contracting & Network Development with solid experience in Medicaid/Medicare contracting and negotiating hospital, large physician groups, and ancillary service agreements. Fantastic opportunity to join our Fortune 100 leading healthcare enterprise experiencing incredible growth and market expansion! Senior Director will oversee the development and implementation of contracting activities in network development and enhancement.Work with Business....


Nationwide Search for Vice President Operations to lead Fortune 100 Healthcare Enterprise. Responsibilities include overseeing business operations, procurement opportunities, new product implementations, complex initiatives for business development. Utilizing cross-functional teams to meet corporate strategic objectives. Direct the development and implementation of operational work processes and systems with direct oversight for multiple departments within the business unit. Partner with....


Seeking: RN, BSN, MSN Leader with experience in Complex Case Management, Disease Management, Utilization Management, Care Management, Quality in a managed care setting with at least 5-7 years experience. Job description OVERVIEW OF POSITION: Responsible for the oversight, management and optimization of all CQI, UM and Care Management activities as they relate to inpatient, social service, home health, DME and other healthcare delivery programs for the enterprise. Participates in the....


Nationwide Search for Director of Risk Adjustment Analytics (T-SQL) to oversee the general organization and efficient management of the Medicare Comprehensive Health Assessment Program (CHAPs) data activities for leading healthcare organization. Includes participation in ongoing data mining and analysis, oversight of, development and delivery of education and identification of opportunities to improve reimbursement through proper coding and documentation. Responsible for the ongoing....


Nationwide Search for the Best in Class of Contract Negotiators in Value-Based and Hospital Contracting. This national leader in healthcare, a Fortune 100 company which provides innovative solutions to over 12 million members, believes their most important assets are its employees. Join their team and help transform the health of the communities they serve, one person at a time. This starts with you, from your benefits to your retirement plan and reaches outwards to community support and....


Seeking local RN leaders with Case Management experience to Manage the day to day operations of the case management department for this healthcare enterprise. Review analyzes of activities, costs, operations, and forecast data to determine progress toward stated goals and statistical/financial purposes. Promote compliance with federal and state regulations and contractual agreements. Develop, implement and maintain compliance with policies and procedures regarding medical case management.....

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