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- 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....


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.....


Seeking Director to head up Membership Administration Systems for this healthcare enterprise. A Highly visible role for Healthcare Leader with experience in Operations, Membership Services in the implementation of Healthcare Health Systems and Large scope multi-year project management. Job description Responsible for the management and leadership of a range of process improvement and process management activities. Activities managed include planning, performing, and implementing process....


Seeking local RN candidates for Manager, Prior Authorization & Referrals. If overseeing day to day functions of the call center that provides preauthorization and referral services to physicians for plan members is your thing. ... then we need you on our team.Oversee preauthorization nurses and referral specialists in their day to day activities including management of talk times, service levels, abandonment rate, and other key quantitative/qualitative factorsDevelop, implement and....


Nationwide Search for Director to lead and coordinate all National Labor Relations to include national initiatives, collective bargaining as well as day-to-day labor relations for Healthcare enterprise.Serves as a key interface between National Labor Relations and its key customers, ensures positive labor relations climate through effective communications, collaboration, persuasion, and problem-solving; demonstrating knowledge and understanding of the national labor relations program and....


Nationwide Search for Actuary and Associate Actuary (Individual Market) for Chicago, Milwaukee, and Calabasas Job descriptionPosition Purpose: Conduct analysis, pricing and risk assessment to estimate financial outcomes. Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomesDevelop probability tables based on analysis of statistical data and other pertinent informationReview insurance plans and calculate required premium....


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.....


Supervisor, Utilization Management (RN preferred) Orlando, FL Currently seeking a Supervisor to lead the daily operations of the utilization management (UM) department in the Orlando, FL area. The ideal candidate will hold a current state's LPN, LVN, or RN license and possess 3+ years of utilization management/quality improvement experience in a managed care environment.. Responsibilities of the Supervisor, Utilization Management Supervise the daily operations of the UM staffEnsure....


Contract Implementation Analyst Columbus, OH Currently seeking a Contract Implementation Analyst for a great opportunity in the Columbus, OH area. The ideal candidate will possess 1+ years of provider contract implementation, contract analysis or claims analysis experience in managed care, health care or TPA setting. Responsibilities of the Contract Implementation Analyst Perform day to day duties and testing of contract implementation, including UAT to ensure that systems accurately....


Architect, Information Technology Chesterfield, MO A National Healthcare Plan Fortune 100 enterprise is currently seeking IT Architect for their expanding team in Chesterfield, MO. The ideal candidate will possess 5+ years of relevant design and architecture experience. Relocation available. Responsibilities of the Architect, Information Technology Develop and drive the standards, development processes, systems architecture, and design patterns to support IT and business....


Supervisor, Utilization Management (LPN, LVN, or RN license needed) Orlando, FL Currently seeking a Supervisor to lead the daily operations of the utilization management (UM) department in the Orlando, FL area. The ideal candidate will hold a current state's LPN, LVN, or RN license and possess 3+ years of utilization management/quality improvement experience. Responsibilities of the Supervisor, Utilization Management Supervise the daily operations of the UM staffEnsure appropriate usage of


Leading multi-line healthcare enterprise offering both core Medicaid and specialty services is seeking a Board Certified Psychiatrist to head up our Behavioral Health unit. Job Description The Medical Director (Behavioral Health) will assist the Chief Medical Director to lead and coordinate the medical management, quality improvement and credentialing functions for this leading health plan through: 1) Medical Leadership 2) Medical Reviews 3) Cost Containment 4) Quality & Performance....


Nationwide Search for Senior Director, Contracting & Network Development 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 Development and Providers to develop a strategy for developing new networks including plans to meet network access and unit cost....

- Yonkers, NY

POSITION OVERVIEW:Provide psychiatric services and care to the agency’s clients, including provision of a full behavioral health (including health) assessment; diagnosis; treatment recommendations; treatment planning; treatment; and follow up planning. The practitioner also provides clinical consultation to agency non-medical staff, is the signature of record for all treatment planning, and participates in the learning environment of the program. Welcoming and inspiring care is provided in....

- Fort Lauderdale, FL

Job descriptionPosition Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. 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 medical services. Supports effective

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