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Medical Management Trainer – Appleton, WI Innovative national health plan! Newly created role will provide hands on training to clinical staff in Medical Management – RN’s and social workers. Great opportunity to influence quality of care for this underserved population. · Develop and conduct clinical educational classes/course · Develop, conduct and ensure maintenance of Case Management (CM) education · Conduct interqual training for CM staff · Conduct training to ensure proper inpatient....

- Appleton/Fox Valley, WI

Training Auditor (Clinical)Be part of a NEW team! You will be responsible for developing and conducting a variety of training programs and auditing tools for the medical managemnet team. You will provide insight to the Managers on areas of improvement and growth needed for the staff. GREAT growth opportunities and generous benefits!Conduct training needs analyses to determine specific training needs for clinical staff Identify, select, or develop appropriate training programs, including the....


Medical Director- Health Plan - OHIO Physicians seeking a purposeful career will appreciate the opportunity to guide and direct the care for the medically underserved population in OH as part of this expanding market. This national organization welcomes your innovative ideas and solutions for closing the gaps in care and quality. Physicians are encouraged to be actively engaged with their patient population and their physician peers in the community. Incredible opportunities for career....

- near Portland, OR

Director, Case Management- near Portland, OR New position offers a nice relocation package & excellent career growth. Bring your innovative ideas and success stories! Director is responsible for defining and directing a complete Case Management Program in conjunction with corporate goals and objectives - Direct the overall operational leadership of case management functions and staff - Perform and oversee needs analysis and planning - Collaborate with executive leadership to ensure targets

- Rancho Cordova, CA

Director, Medical Management - CA - NEED 2 New region opening and it's a GREAT opportunity to bring your own ideas and creativity. Strong leadership support of programs of care management. Director will work closely with the Medical Informatics team to identify trends that need to be addressed with program management.- Responsible for Care Management clinical inter-rater reliability and monitoring important aspects of care.- Effectively manages the activities of staff providing leadership and....

- Seattle or Tacoma, WA

Medical Director – Behavioral Health – Seattle Area New role in the organization will collaborate with the VP of Medical Affairs to direct and coordinate the physician component of the utilization management functions for the local health plan, with emphasis on the behavioral component of the integrated care programs. · Provides medical leadership for utilization management activities and medical review activities pertaining to utilization review, quality assurance, medical review of complex,....


Director, Utilization Management - PA Award –winning programs of care, advanced technology & analytics, GREAT leadership. RELOCATION offered – must have or be able to secure RN license in PA Lead the operations of the referral management, telephonic utilization review, prior authorization functions, and case management programs, ensuing compliance government and contractual guidelines Oversee the operations of the referral management, telephonic utilization review, prior authorization, and

- Eau Claire, WI

CARE MANAGER II- Eau Claire, WI – 2 positions Newly expanded market – chance to be part of a start up team This role will be 50% field – 50% telephonic Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. - Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term....


Sr Director, Provider Contracting – Columbus, OHIO Great manager – highly motivated team –relocation offered. Growing health plan needs a strong communicator with a deep knowledge of value- based contracting and proven ability to build relationships with providers and senior leadership. Drive the development and implementation of network contracting and network development. · Direct the evaluation, review, negotiations and ongoing management of product-specific contracts and amendments between


Director, Claims | Contract Support Services – Columbus, OH Positive, collaborative culture and an exceptional mentor make this a very attractive opportunity in OHIO. Unlimited career potential here- and our client will provide you with an excellent relocation package. Direct the strategic analysis and accuracy of claims processes and oversee and ensure compliance with state regulations and/or provider contracts · Oversee the collection, validation and analysis of data to deliver business....

- Greater Los Angeles, CA

Director, Public Programs & LTSS – Glendale, CA High-visibility position with significant impact and influence on how we improve the lives in our communities. This organization offers unlimited career growth. Relocation package offered – generous comp and benefits. The Director Public Programs and Long Term Services and Supports (LTSS) drives company’s Public Programs overall strategy and oversees integrated medical, behavioral and social services for a large, complex program. The Director


Director, Utlization - Medical Management - Harrisburg, PAUnique opportunity for an experienced leader to select and develop your own team. Generous relocation- excellent analytic tools and support. - Direct medical management program including UM, case management, QI and credentialing. - Develop department objectives and implement action plans to achieve objectives. - Evaluate and implement changes to medical service functions and performance. - Manage budget and forecast for strategic....

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