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- Any US State
new job!

Can You Manage the Western US?If so, this privately held, $30m+, medical supply and DME company wants to speak with you!We are looking for 2 Managed Care Territory Managers (Eastern US and Western US) to expand their business with new and existing clients. This a new position, reporting directly to the CEO. Operating remotely, the Territory Manage will enjoy a mid to high $100k base salary, bonuses, and comprehensive benefits.The company wants to speak with Managed Care professionals with....

- Upstate, NY
new job!

Six Figure Salary + Relocation Expenses Under the general guidance of the Vice President for clinical services, provides strategic and operational leadership to the Physical Rehabilitation department, providing leadership of individual employees and work teams to achieve defined goals, objectives and outcomes in service, quality, finance, engagement and growth and providing for the efficient management of department resources to achieve goals and outcomes. The Director is also expected to....


Director, Clinical Operations (Behavioral Health) Be part of the leadership team for a market expansion. Talented team and strong opportunity to make a difference in your career and in the lives of the medically underserved. Director will oversee clinical functions in all service areas including: intensive case management (ICM), utilization review (UR), provider training and care coordination in collaboration with other senior leaders. Director will work to manage complex behavioral health....


....SVP of Health Services (RN) | Executive Leader - Health Plan - Chicago HIGHLY VISIBLE opportunity working closely with the CEO. GENEROUS RELOCATION - strong analytics support- collaborative team! You will establish the strategic vision for this plan, directing and coordinating the medical management, clinical services, and quality improvement and credentialing functions across the IL market. - Team - building and collaboration with internal and external constituents will be key. -....


...VP Health Services | Medical Management (RN) - KANSAS Exceptional analytic support – unlimited career growth .....Reporting to the CEO, experienced clinical leader will establish the strategic vision and drive initiatives around programs of care management and quality. Collaborative participation with the exceptional leadership team in this market is a strong platform for success. Established business and new product are rolling out in KS. Direct and coordinate activities of department and....


Director, Utlization - Medical Management - MAITLAND, FL Nice opportunity for an experienced leader to be part of a growing 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 planning and key

- Orlando/Maitland, FL

CARE MANAGER II - Maitland/Orlando - Health Plan - 8 neededMake a positive impact on members lives by helping them improve their health and access to care.Great opportunity to join a new team rolling out a new product in Florida. Supportive manager and unlimited growth- no on call or weekends! RN will 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. This may include assess the....


Operations Director | Government Liaison - Health Plan Open due to promotion, this multi-faceted role will interface with external and internal stakeholders to maximize outcomes, quality, and profitability for national health insurer. Exceptional boss - strong growth potential. Director is responsible for the oversight of the many moving parts of enrollment, claims, and all other essential administrative components, with a focus on continuous improvement of operational efficiency as well as....


Director, Medical Management Operations - TempeRapidly expanding market - national healthcare enterprise!Innovative, process- driven leader will be called on to lead Medical Management process improvement initiatives to reduce medical costs, reduce administrative costs, and improve member quality. Assist Medical Management clinical leadership team to establish baseline and target metrics for key business/functional processes Develop and analyze reports across multiple systems to analyze key....


MANAGER, UM – Behavioral Health Perform duties to conduct and manage the day to day operations of the utilization management functions to include denials. Communicate with departmental and plan administrative staff to facilitate daily operations of the utilization management functions. - Ensure compliance with established referral, pre-certification and authorization policies, procedures and processes - Facilitate ongoing communication between care management staff, utilization management....

- Tacoma, WA

MANAGER, UM- Tacoma Growing team needs a strong leader and mentor for their UM nurses. Excellent communication with staff to enhance & facilitate daily department function is essential. GROWTH potential is excellent- rich benefit package! - Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives. - Promote compliance with federal and state regulations and contractual agreements. - Develop, implement and maintain....


Director, Provider Network Management & Payment Innovation – Tempe, AZ Generous relocation package- NEW position. Are you a MASTER of Value-Based contracting with a passion for implementing best practices? Director leads a cross-functional team and works across the health plan to implement targeted value based contracting initiatives (Pay for Performance, Shared Risk and Reward, Accountable Care Partnerships). Identifies best practice and “center of excellence” opportunities and implement....


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....

- 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....

- SEATTLE/TACOMA/Wenatchee, WA

CARE MANAGER II (RN) - SEATTLEINNOVATIVE 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 options Utilize....


Manager of Utilization Management – Dental Hygienist – TAMPA - FLORIDA RDH Salary is generous! Fortune 100 dental health insurance – so much room to grow – WONDERFUL benefits! Active Registered Dental Hygienist – any state Must work in Tampa – NICE relocation package! Perform duties to conduct and manage the day to day operations of the utilization management function. Communicate with staff to facilitate daily department functions.Review analyses of activities, costs, operations and forecast....


Sr. Contract Negotiator- HEALTH PLAN - Bedford,NH Very visible role engaging with CEO’s, CFO’s, Board of Directors to present data and work through contract specifics with providers. Company offers exceptional analytics support and generous benefits and career growth. Sr. Contract Negotiator will coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi specialty groups) and ancillary service agreements that are in accordance with corporate, health plan and State....

- Pittsburgh or Harrisburgh, PA

Medical Director – Pittsburgh, PA Physicians – are you looking for a purposeful career that will allow you to broadly improve care for the medically underserved? This organization offers this – and so much more…career growth is unlimited here. Assist the VP of Clinical Programs to direct and coordinate the physician component of the utilization management functions for the PA market. Great opportunity to influence your peers in the medical community. · Provides medical leadership for....


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

- Appleton or Eau Claire, WI

Behavioral Case Manager – Appleton or Eau Claire, WI – 3 new positions - CHOOSE a location! New market area will need clinician who enjoys some field work and travel within northern WI…fully integrated program of care. -Perform duties related to the day to day operations of the Integrated Case Management functions to include 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....

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