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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....

- Seattle or Tacoma, WA
new job!

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,....

- Columbus, OH
new job!

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....

- Eau Claire, WI
new job!

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....

- Eau Claire, WI
new job!

Behavioral Case Manager – Eau Claire, WI – 3 new positions 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 issues. -Assess members’ current....

- Eau Claire, WI
new job!

Manager, Case Management – Eau Claire, WI Serve as the leader for this newly established satellite office. Lead the daily operations of case management function. Reporting to a Sr Director in the main office, Manager will have responsibility for maintaining effective communication. Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes.Promote compliance with federal and state regulations and contractual....

- near Portland, OR
new job!

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

- Milwaukee, WI
new job!

VP, Health Services | Medical Management - Milwaukee, WI Generous relocation & perks, including TUITION & stock optionsJoin an already successful leadership team as they continue to improve outcomes and quality in WI. VP will establish and implement the strategic vision for all medical management and quality functions. This is an IDEAL opportunity to bring your innovative ideas and success stories to an organization that values and listens to their clinical leadership. Exceptional....

- 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....


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

- 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....

- Greater St Louis, MO

Chief Medical Officer – Missouri Ideal role for an experienced physician seeking a purposeful career with an opportunity to directly and broadly impact the medically underserved. As part of the executive leadership team in this market, you will help to grow the organization and have strong influence over clinical and non-clinical issues Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the....


Director, Case/Medical Management – ANY CITY - OHIO ** Will cover Northwest market - Toledo area- can sit in Columbus, Cincinnati, Cleveland/Akron or Toledo/Maumee Innovative health plan is continuing to expand in Ohio. Director will be responsible for defining and directing a complete Case Management Program for a vulnerable population. · Direct the overall operational leadership of case management functions and staff · Perform and oversee needs analysis and planning · Work with executive....

- Indianapolis, IN

Medical Director- Health Plan - Indianapolis, IN Physicians seeking a purposeful career will appreciate the opportunity to guide and direct the care for the medically underserved population in Indiana. 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 advancement. Assist the


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....

- 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


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....


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

- 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 undeserved 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....


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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