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Manager, Medical Management - Appleton, WI Provide leadership for experienced clinical team in growing satellite office (12 direct reports), Manager will be responsible for managing a complete program of medical management in accordance with the mission, philosophy, and objectives of plan. Oversight includes both UM and CM. Manager will implement changes to medical service functions and performance in relation to company mission, philosophy objectives and policies, as directed. Manage budgets....


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


VP, Provider Contracting | Network | Strategy OREGON - Portland | Eugene STRONG leadership team - GREAT relo & benefits. Experienced strategist with exceptional relationship - building skills will direct the provider network and contracting activities across the OR market for multiple product lines. Responsible for analysis, network operations and supporting decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for the....

- St Louis, MO

VP, QUALITY - MCO - St Louis EXCEPTIONAL leadership team - GENEROUS RelocationWorking closely with the Chief Medical Director and the CEO, VP will oversee all related activities for Quality Improvement functions. Lead and direct process improvement activities for more efficient and streamlined workflow. Oversee the business processes related to risk adjustment and quality improvement for assigned products and plans.Responsible for all activities related to National Committee for Quality....

- Indianapolis, IN

Director, UM - Indianapolis, IN Amazing growth continues with this national firm - award winning programs of care and a chance to TRULY make a difference for the medically underserved population in INDIANA. 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 and....


Case Manager II - RN - office or field based - TWO positions 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.Innovative health plan truly values their nurses. 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. PCP, specialist, and


Senior Director, Quality – FLORIDA _____________________________________________________________________ Incredible growth potential - generous relocation to SUNNY Florida! If you enjoy taking the lead in NCQA accreditation - this may be the new job for you! Sr Director will utilize proven success in moving the needle by directing process improvement activities to improve and streamline workflows across the Florida market. Responsible for NCQA and HEDIS performance. Ensure health plan is....


VP Medical Management | Health Services - Ft Lauderdale, FL VP will be a part of strong & collaborative leadership team with daily interaction with C - Suite executives. Incredible growth opportunities and perks for this executive role GENEROUS relocation & competitive compensation. Direct and coordinate the medical management, quality improvement and credentialing functions for the for the Florida market, establishing the strategic vision and policies and procedures for the entire....


Behavioral Case Management (Social Worker) – Eau Claire, WI As a team member in Integrated Case Management, you will be working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members’ current functional level and, in collaboration with the member, develop and monitor the Case Management Care Plan, monitor quality of care; assisting with discharge planning, participating....


Sr. Director, Claims Operations - St. LouisBuild a best in class claims system - exceptional opportunity for someone who enjoys driving change. Ideal candidate will have exposure to multiple different claims systems and the ability to act as an internal consultant within technology and business groups, using quality tools and process definition/improvement to re-engineer technical processes for greater efficiencies.-Direct the day-to-day operations of the Claims Department to ensure accurate....


INDEPENDENT THINKER | SELF STARTER | HR VETERAN Does this sound like you? Can you lead all HR functions for a start-up call center operation? If so, this may be your next career challenge! A nationwide company is starting a call center operation in Nashville. They need a veteran call center HR Business Partner or Manager to step in, quickly take the reins, and build the call center team. You'll function independently as the sole HR team member in Nashville as an extension of the corporate....

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