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Senior Director, Claims Transformation (NATIONWIDE SEARCH) Saint Louis, MO Currently seeking a Senior Director for a Claim Department in Saint Louis, MO area. The ideal candidate will possess 8+ years of claims operations, project management, process improvement or shared services experience, preferably in a managed care and/or Medicaid setting. This individual will direct the day-to-day operations of the Claims Department to ensure accurate and timely processing of members medical claims....

- Upstate, NY

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....


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....

- Saint Louis, MO

Data Analyst IV (HEDIS, BIG DATA, MICROSTRATEGY?) Saint Louis, MO 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 support....


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 (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. Responsibilities of the Supervisor, Utilization Management Supervise the daily operations of the UM staffEnsure appropriate usage of resources in....


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


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....


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....

- Harrisburg, PA

Job descriptionPosition Purpose: Coordinate, negotiate and handle activities of the provider contracting, network development and/or provider relations functions and aid in formulating and administering organizational policies and procedures. Negotiate large hospital, physician groups and ancillary service agreements in accordance with Corporate, health plan and government regulations and guidelines. Reports to the VP Network Development & Contracting Oversee provider contracting....


As a SME for Application Software developers and Engineers, you will design, build, test and maintain scalable and stable off the shelf application or custom built technology solutions to meet business needs. Multiple positions and locations available! Senior Application Software Engineers: MISSOURI - Business Intelligence - Software Development - C#/Java - Full Stack Developers - Core Systems - ETL, Data Modeling - Electronic Data Interchange - Informatica - Enterprise Content / Data....

- 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

- Chicago, IL

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 ratesEnsure cash reserves and liabilities enable payment of future benefitsDetermines equitable basis for....


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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