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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....


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, 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.....

- Orlando, FL

Exclusive Search for Director, Marketing to oversee creative marketing programs to brand and promote the organization.at the corporate and national level. · Responsible with establishing and maintaining the marketing department’s strategic vision, video storytelling, and visual brand, objectives, and policies & procedures · Direct fresh ideas, creative content, and marketing programs for this corporation and its entities · Interpret and clearly communicate relevant corporate strategic....


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.....


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....


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....


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....


Seeking Electrical Engineer - Solid State Drive (SSD) for a leading enterprise providing mission-critical solutions to government and civilian agencies to combat a growing number of cyber-attacks on their systems. We provide training, certification, and vulnerability compliance assessment, focusing on C41SR solutions using any type of network; mobile, fixed, static, terrestrial, marine, airborne or in space. Our market segments consist of Tactical Communications, Space & Component....


Exclusive Search for Regional Medical Director to serve as liaison for the health plan. Responsibilities and focus to ensure that all the opportunities are highlighted through detailed reporting to the leadership building creditable and trusting relationships with stakeholders regarding performance metrics and serving as the clinical lead with large employer groups in the bid process. Manage assigned departments or functions with an emphasis on execution, outcomes, continual improvement and....


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....


Exclusive, Nationwide Search for a strong dynamic 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 corporate staff in formulating

- 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....


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....


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

- Orlando, FL

Exclusive Search for Director, Marketing to oversee creative marketing programs to brand and promote the organization.at the corporate and national level. · Responsible with establishing and maintaining the marketing department’s strategic vision, video storytelling, and visual brand, objectives, and policies & procedures · Direct fresh ideas, creative content, and marketing programs for this corporation and its entities · Interpret and clearly communicate relevant corporate strategic....

- Murphysboro, IL

Exclusive Search for HR Business Partner responsible for HR strategies for large enterprise to drive the HR agenda, partnering closely with Centers of Expertise (COEs), HR Operations and key business unit leaders to effectively and efficiently deliver HR processes and initiatives for the business unit.Responsible for coaching the front line people managers and partner with them to resolve employee-related mattersDevelop and analyze HR data to guide business leaders in planning and execution of

- St Louis, MO

Exclusive Search for Finance/Data Analyst with 6+ years complex and high-level financial analysis experience to lead various financial projects. Focus: Cost-effectively manage the utilization of services and develop measures to track, trend and forecast related impacts of organizational strategic initiatives. Run pre-established reports as well as development of new reports for internal stakeholders and regulatory agenciesDevelop metrics to evaluate financial impact of proposed contract....


Exclusive, Nationwide Search for a strong dynamic 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 corporate staff in formulating


Exclusive Search for Regional Medical Director to serve as liaison for the health plan. Responsibilities and focus to ensure that all the opportunities are highlighted through detailed reporting to the leadership building creditable and trusting relationships with stakeholders regarding performance metrics and serving as the clinical lead with large employer groups in the bid process. Manage assigned departments or functions with an emphasis on execution, outcomes, continual improvement and....

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