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Position Purpose: Position Responsibilities: Develop a roadmap and plan for Continuous Feedback and Delivery initiatives. Build platforms that teams can leverage to accelerate innovation in the areas of reliability, scalability and velocity. Develop cross functional code base for automation. Mentor team members in object oriented programming strategies. Provide technical leadership for software development and software operation transformation initiatives. Implement and customize service mesh....


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....

- Richmond Heights, MO

Position Purpose: Design, build, test and maintain scalable and stable off the shelf application or custom built technology solutions to meet business needs. Act as a subject matter expert for Application Software developers and Engineers. · Contribute to the entire implementation process including driving the definition of improvements based on business need and architectural improvements · Meet with business partners to understand business needs · Responsible for overall design of the....


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 Director, Utilization Management (RN) for large Fortune 100 enterprise. Job descriptionOversee operations of the referral management, telephonic utilization review, prior authorization functions, and case management programs. Ensure compliance government and contractual guidelines and the mission, philosophy, and objectives of Corporate and the health plan. Support and perform case management, disease management, and on-site concurrent review functions as necessary.....


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....


What's Exciting About This Opportunity? Dreaming of a better place to work? Look no further. We are regularly recognized by our employees as a Best Place to Work and consistently win workplace excellence awards. We offer competitive compensation and a comprehensive benefits program including an ESOP (Employee Stock Ownership Program), training, professional development, membership in professional associations and much more. All of our offices provide employees with a relaxed, collegial and....


Job description Reporting to a Plant Controller, the Assistant Plant Controller is responsible for a variety of accounting and finance assignments, partnering with the site management team to successfully manage the manufacturing operations and meet financial objectives. This role supports two plant locations - South Gate, CA and Jackson, MS. The successful candidates may be based out of either facility with the understanding there will be some travel required to the other facility. The South....


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....

- St Louis, MO

Exclusive Nationwide Search till 12/4/2018 for Director, Talent (Strategy & Solutions) to head up the organizational development needs of large healthcare enterprise to enhance the performance, quality and motivation of staff; effectiveness of organizational development interventions and develop and conduct training programs. Assist SVP, Talent & Organizational Development with Succession Planning and Management process leading to effective Development PlanningPerform group development


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....


Job description Overview Seeking an experienced Senior Information Security Risk Analyst to join our team of talented professionals in Bethesda, Maryland.How many times in your career do you get the opportunity to do something that’s never been done? To create something that will change an entire industry? We are building a Platform to issue and manage mortgage securities. We’re looking for people who can walk in two worlds – a start-up environment where development is collaborative and rapid;


Data Analyst IV (HEDIS, BIG DATA, MICROSTRATEGY) 2 positions available Currently seeking a Data Analyst IV for a great opportunity in Saint Louis, MO area. The ideal candidate will possess 6+ years of statistical analysis or data analysis experience and preferably have healthcare experience. Responsibilities of the Data Analyst IV Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data Analysts.Provide advanced analytical....


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....

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