1-20 of 22 results
Sort By

- Indianapolis, IN
new job!

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.....

- Maryland Heights, MO
new job!

Nationwide Search for Vice President, Quality & Process Improvement (Health Plan) (RN, CPHQ) Position Purpose: As the senior leader, reporting to the Chief Medical Director, you will be responsible for developing and overseeing the quality improvement functions.. To be part of the leadership team to lead and direct process improvement activities, streamline the workflow for a more efficient process. To oversee business processes related to risk adjustment and quality improvement activities


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....

- Chesterfield, MO
new job!

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.....


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....


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 a high-level nurse leader with a decade of medical management experience to lead a strong dynamic team part of a Fortune 100 growing enterprise. 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. Must have Managed care NCQA/HEDIS Medicare/Medicaid/Exchange Managing Direct Reports....


Job description This position reports to the Director of Provider Contracting & Network Management to support the contracting activities of the Medical Group and Health Plan. Responsibilities include managing outside medical cost through contracting initiatives, analysis of financial reports and trends in the marketplace covering IPAs, PHOs, hospitals, and key specialty services. Contractual arrangements will be complex and comprehensive, needing a depth of understanding of managed care;....


Many opportunities for advancement with this Fortune 100 Enterprise for the right candidate that posses a decade of leadership in network development and provider relations/contract management in a managed care environment! Job descriptionDirect the provider network and contracting activities leading all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management. Oversee the....


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....


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....


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


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....

- 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....

1-20 of 22 results