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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


Job description Senior Attorney, Global Intellectual Property – Salary Negotiable + 20% or Higher BONUS LOCATION: Atlanta, GA (NO RELO) Do you earn to work with a global tech company—that runs the everyday transactions that make your life easier? Join the world leader in consumer transaction technologies, turning everyday interactions with businesses into exceptional experiences. With our software, hardware, and portfolio of services, we make more than 600 million transactions possible....

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