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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....


Join one of California’s Top 10 largest Commercial Banks. The company is looking for outstanding people to join their winning team. They have reached their current strength because their employees, customers, and shareholders believe in the same fundamental goals: Delivering a wide variety of financial services with a superior customer service guarantee.Our client is a 130 year old community bank with $4.9 billion in assets and 88 branches throughout Northern and Central California. They have....

- Seattle, WA

This position works with a team of analysts and actuaries to support premium rate setting, provider contract analysis, network analysis, Medicare bid submissions, underwriting, financial accounting entries, and other financial risks associated with health insurance related to the Medicare Advantage line of business. The Senior Risk Analyst both performs basic and complex analysis of business strategies, and communicates their findings to others in the organization. They may be asked to lead....


Our client is a global technology leader in the production of specialty materials and chemical products which are used in most major industries and consumer applications. The have manufacturing operations in North America, Europe and Asia. The company employs approximately 7,500 employees worldwide and had 2014 net sales of $6.8 billion, with approximately 67% generated outside of North America. The Human Resources Business Partner is responsible for partnering with all levels of the....


Get in on the ground floor! Here's your chance to build and expand the Physical and Occupational Therapy Services at a new National health care company's clinic in the Spokane area.As the supervisor, you will have the opportunity to grow and market existing therapy services to the internal and external community. In addition, you will supervise and participate in the daily operations of the physical and occupational therapy departments. Along with administrative duties, 50% of the position is....

- Rockville, MD

Lead, coach and develop professional sales staff in new group sales in order to achieve membership and margin targets, continually improve performance and translate key initiatives into action. Conduct day to day management of sales team for assigned market segment. Achieve commercial new group membership enrollment forecast for assigned segment. Monitor daily performance and workflow of sales staff to deliver on expectations for quota achievement, sales pipeline development. Manage and....


Responsible for managing the strategy and performance of a product line or product family in support of the region's profitability and membership goals. This also includes the facilitation of corrective actions to support financial and operational performance. Manages the region's portfolio planning process across specific lines of business. Interacts with national and regional partners to ensure alignment and feasibility. Manages the development and implementation of new products and/or....

- Tampa, FL

VICE PRESIDENT, OPERATIONS – TAMPA Exceptional career opportunity – must be prepared for increasing responsibility in leadership and quick advancement. Generous relocation package and rich benefits- UNLIMITED growth. Broad span of operational control with newly established division of major corporation. Growth has been rapid and continued growth is imminent. VP will oversee business operations, procurement opportunities, new product implementations and complex initiatives for business....


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....


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....

- 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....


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....


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,....


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....

- 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....

- 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....


Manager, Finance- AtlantaYou will be mentored by an exceptionally talented team of analytics and finance professionals as part of this growing healthcare enterprise in the Atlanta area. Career opportunity is unlimited here!Manager will focus on revenue optimization and risk adjustment activities, overseeing the development of various analytical reports and performing complex financial analysis. Supervision of 1-2 analysts. - Ensure that timely and accurate reports are generated - Produce and....


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

- Director,Contracting, PA

Director, Contracting & Network Working closely with the VP, Director drives daily activity of the provider contracting, network development and/or provider relations functions for this new market. GENEROUS relocation - UNLIMITED career growth ! -Recruitment and contracting of provider networks in new and prospective markets, and existing market expansions. - Support new business launch in diverse markets by considering individual market circumstances, provider community, budgeting....

- Milwaukee, WI

MANAGER, CASE MANAGEMENTThis leading healthcare enterprise truly values their nurses. They offer innovative products and sophisticated analytic tools An experienced RN with case management will lead the continuing growth of the team in the WI market. Leader will develop and implement case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure. Review analyzes of activities, costs, operations and forecast data to determine progress

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