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Seeking high-level Senior Nurse leader to provide leadership and direction of the case management plan across the enterprise-wide continuum of care to meet the company's mission, values, goals, and objections. Reporting to the Chief Financial Officer, the Executive Director of Population Health/Case Management will be responsible for the development, implementation and ongoing review of the enterprise-wide continuum of care case management integrated system.Participates with leaders of the....


Strong dynamic team part of a Fortune 100 growing enterprise is seeking a 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....

- Close to Hot Springs, AR, AR

Title: Vice President, Quality & Process Improvement (Health Plan) Location: Arkansas Are you someone that likes variety and enjoys all four seasons? Looking for a place to live and enjoy the outdoors? Would you love to wake up and take an easy drive up to the Pinnacle Mountain State Park, go hiking in Ouachita National Forest, or photograph the stunning Ozark Mountains? Do you prefer just spending a day relaxing in the Hot Springs or taking in a round of golf? This is the perfect place....


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 implementation of performance....


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. Location: This position can be remote anywhere in Texas if not local to Dallas, Austin or San Antonio. 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....


Vice President Network Development & Contracting Seeking a Change Agent motivated to get things done with a strong background in value-based contracting and knowledge of public policy for this leading healthcare enterprise! Reporting directly to the SVP Operations, the VP Network Development & Contracting will Direct the provider network and contracting activities, Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers....


Vice President Network Development & Contracting Seeking a Change Agent motivated to get things done with a strong background in value-based contracting and knowledge of public policy for this leading healthcare enterprise! Reporting directly to the SVP Operations, the VP Network Development & Contracting will Direct the provider network and contracting activities, Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers....


Vice President, Medical Management (RN) Fantastic opportunity to join our Fortune 100 leading healthcare enterprise experiencing incredible growth and market expansion! Direct and coordinate the medical management, quality improvement and credentialing teams/functions in support of the company’s strategic plan; establishing the strategic vision and attendant policies and procedures for the health plan.Direct and coordinate activities of department and aid the chief officer of the health plan....


If Promoting the quality and cost-effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests is what you live for, ... then we need you on our team.Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other....


Do you want to be part of something remarkable?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; and a production environment where we run and monitor the performance of the platform. Longer-term, this....


Seeking a Senior leader with an executive presence in Health Plan Operations for one of Fortune's list 100 Fastest Growing Companies. Overseeing all functions of the Foster Care program including behavioral and medical health, you will develop, implement and operate health programs and initiatives for the Foster Care population of the Health Plan. Responsibilities include:Ensure effective management of care to all foster children under contract by overseeing foster care operations and....

- 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....

- Santa Monica, CA

Seeking a Director Case Management for a large integrated not-for-profit Health Care Organization that shares a commitment to providing quality care for all. Responsible for the clinical, fiscal, and personnel management of Case Management on a 24 hour, 7 day basis Support and promote the mission, vision, and objectives of the Health Care Organization Develops and utilizes mechanisms for directing, evaluating and controlling operational activities towards accomplishments of division....


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

- Saint Louis, MO

Conduct analysis, pricing and risk assessment to estimate financial outcomes. Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes Develop probability tables based on analysis of statistical data and other pertinent information Review insurance plans and calculate required premium rates Ensure cash reserves and liabilities enable payment of future benefits Determine equitable basis for distributing money for insurance....


Director, Case Management Fantastic opportunity to join Fortune 100 leading healthcare enterprise experiencing incredible growth and market expansion. Responsible for defining and directing a complete Case Management Program in conjunction with corporate goals and objectivesDirect the overall operational leadership of case management functions and staffPerform and oversee needs analysis and planningWork with executive leadership to ensure targets are met for the annual operating plan/financial


Responsible for defining and directing a complete Case Management Program in conjunction with corporate goals and objectivesDirect the overall operational leadership of case management functions, including utilization management and staffPerform and oversee needs analysis and planningWork with executive leadership to ensure targets are met for the annual operating plan/financial managementEnsure compliance with Corporate, State and NCQA standardsDevelop and implement methods, policies, and....


Senior Director, Medical Management (RN) I - Health Plan Working directly with the VP Medical Management, the Senior Director of Health Services will direct medical management programs including utilization management, case management, and quality improvement in accordance with the mission, philosophy, and objectives of the plan and in conjunction with Corporate goals and objectives.Develop department objectives and organize activities to achieve objectives.Evaluate and implement changes to....


We are in search of an RN or Healthcare Administrator to manage the Medicare STARs across our client company’s Medicare Plans. Here is what our qualified candidate looks like:Experience in STARS and leading STARS Program.7+ years of managed care experience – MedicareKnowledge of Center for Medicare/Medicaid Services, requirements for Special Needs Plans (SNP), Medicare Medicaid Plans (MMP) and NCQA oversight requirements preferred. Previous management experience.Bachelor's degree in....


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 objectives.Determine necessary....

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