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- Chicago suburb, IL

Sr. Director, UM - Chicago Suburb Amazing growth continues with this national firm - award winning programs of care and a chance to TRULY make a difference for the medically undeserved population in Illinois. Benefits are excellent- career advancement opportunities are unlimited Director will join an already successful team and have oversight for referral management, telephonic utilization review, prior authorization functions, and case management programs and ensuring compliance government....


Supervisor, UM - Bedford, NHInnovative health plan continues to expand. Supervisor will lead and mentor the UM staff, including identifying opportunities for process improvement. Benefits and perks are great – growth opportunities are unlimited!!! - Ensure appropriate usage of resources in order to facilitate the UM process - Ensure compliance within applicable state program guidelines - Evaluate compliance policies and procedures and analyze/recommend enhancements - Assist with ensuring....


Manager, Clinical Services - Manchester Are you a social worker with a passion for work with children and juveniles? Be part of a team that makes a BIG difference for people with complex needs. Create and deliver community-first solutions : housing, employment, case management, foster care, crisis management, and supports people with emotional and behavioral needs.- Oversee intensive case management and therapy services to ensure the quality of services. Serves as the leader to the treatment....


Director, Finance – Health Plan – Chicago area Excellent mentor – unlimited career growth- newly expanding team…these are just a few reasons to consider a career with this national organization. Reporting to the SVP, the Director will oversee all activities of the business unit’s finance department and aid in formulating and administering organization financial policies and procedures. · Monitor business processes and systems to assure integrity in information and systems · Oversee preparation


Medical Director – Immediate opportunity in Baltimore, MD Physicians who are looking for a purposeful career will enjoy this health plan's focus on improved quality and outcomes for the underserved population. You will work with an exceptional CMD, enjoy extensive analytic support along with an opportunity to collaborate on care management and quality initiatives. Medical Directors assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and....

- Maitland or Sunrise, FL

Director, Case ManagementINNOVATIVE health plan truly values their nurses . The Director will be engaged in creating, defining and directing a complete Case Management Program across a diverse population.This will encompass needs analysis and planning; working with executive leadership to ensure targets are met for the annual operating plan; ensuring compliance with Corporate, State and NCQA standards. Director will be asked to develop and implement methods, policies and procedures to improve....


SVP of Compliance -Wisconsin Leading healthcare enterprise - excellent team work - generous relocation package. Strong, transparent leadership team seeks a compliance executive who will continue the already successful programs and contribute to the continued growth in this market. The VP will work as a partner to the CEO and participate in meetings with a high-powered Board. SVP will serve as a key part of the local leadership team ensuring health plan and corporate are in compliance with....

- Waltham, MA

Utilization Manager – Waltham Continued growth in this northeast market has created a need for an additional behavioral health clinician to be a part of a program of integrated care. No nights, no weekends, no “on call” …..office -based role with great benefits and growth potential too! Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial....

- SEATTLE, TACOMA, or YAKIM, WA

CARE MANAGER II (RN) - SEATTLE, TACOMA, or YAKIMAINNOVATIVE health plan is known for award winning programs of care. Join a growing team with exceptional leadership!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 goals, treatment and provider....


DATA ANALYST | HEALTHCARE ANALYST II – INDIANAPOLIS Fortune 200 Healthcare Enterprise offers an innovative environment with continuous opportunities for learning and growth. Rich benefit package- great work-life balance. Assume responsibility for complex data requests, reports, and predictive data modeling. -Analyze health management programs including: data collection, validation and outcome measurement. May include: - Financial, pharmacy, claims, provider, and member data - IRS, CMS, HHSC,....

- Milwaukee, WI

Case Manager II - RN Innovative health plan truly values their nurses. This health plan has received numerous awards for their programs of care ! They offer generous benefits and PLENTY of opportunity to grow in your career RN will coordinate continuum of care for select members with complex medical and/or behavioral health conditions to ensure they receive the highest quality most effective care while maintaining cost effectiveness. Activity will include advanced review of admissions through....

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