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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....

- Columbus, OH
new job!

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

- St Louis, MO
new job!

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
new job!

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....

- Sunrise, FL
new job!

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....

- Baton Rouge, LA
new job!

VP, Health Services | Medical Management - Baton Rouge___________________________________________________________VP will be a part of strong & collaborative leadership team with the opportunity to be a key strategist in this market. Incredible growth opportunities and perks for this executive role GENEROUS relocation & competitive compensation. ** We are seeking an experienced leader with a proven background in an MCO/health plan/ACO. Direct and coordinate the medical management,....

- St Louis, MO
new job!

Director, Quality Improvement_____________________________________________________________Director will work closely with the VP across all product lines for the growing Missouri market Exceptional growth- generous relocationLead and direct process improvement activities that provide more efficient and streamlined workflow.Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information....


MEDICAL DIRECTOR – Provider Performance - MCO ______________________________________________________________________________________________________ This UNIQUE opportunity will focus on provider engagement and achieving performance results in value based care by providing support and influence and bringing insight, innovation and opportunities to the physicians. MD develops understanding of value-based contracts across lines of business in a region and around cost of care and analytic tools....


Vice President, Network Development | Provider Engagement | Contracting – St Louis _______________________________________________________________________________ Incredible growth and market expansion has created the need for strategic leadership in provider contracting and network development across all product lines. VP will drive value based contracting initiatives and structure collaborative relationships with key providers in the market through sharing of data and best practices. This is


Market CFO | Vice President, Finance - NEBRASKA ________________________________________________________ Successful health plan is financially strong and positioned for exponential growth through market expansion and product diversification. This innovative organization is interested in an executive who is a forward- thinking financial strategist. VP will be a key player on the leadership team, with focus on financial reporting, forecasting, enrollment, reimbursement, rate setting, identifying


Director, Claims Configuration – Tempe, AZ _________________________________________________________ Full relocation package to Tempe – exceptional career growth ! Experienced Director will have ownership of the claims configuration and pricing/benefits set up within the claims payment system, ensuring accurate reflection of provider contracts and claims payments - Ensures timely and accurate configurations and pricing/benefits set up for new business implementations - Ensure changes in....


Sr. Director, Business Operations- MCO- Austin, TX _________________________________________________________________________ Excellent opportunity to make a direct impact on the success of this international healthcare enterprise by driving quality and process improvement and developing an exceptional team. Generous relocation- UNLIMITED career growth locally & nationally Oversight for operations programs in multiple service areas including billing and enrollment, call center, customer....


GROUP HEALTH | SALES EXECUTIVE | EXCLUSIVEWhat does every sales professional want? Something their prospects want to buy, something different, and something better than what the competition has to offer! What if you could have this and the backing of a large, national brand with a 50 year history of success? Now you can have both! Our client is a subsidiary of one of the largest employee benefits plans in the country. They offer ACA-Certified innovative group dental plans across multiple....


GROUP HEALTH | SALES EXECUTIVE | EXCLUSIVEWhat does every sales professional want? Something their prospects want to buy, something different, and something better than what the competition has to offer! What if you could have this and the backing of a large, national brand with a 50 year history of success? Now you can have both! Our client is a subsidiary of one of the largest employee benefits plans in the country. They offer ACA-Certified innovative group dental plans across multiple....


GROUP HEALTH | SALES EXECUTIVE | EXCLUSIVEWhat does every sales professional want? Something their prospects want to buy, something different, and something better than what the competition has to offer! What if you could have this and the backing of a large, national brand with a 50 year history of success? Now you can have both! Our client is a subsidiary of one of the largest employee benefits plans in the country. They offer ACA-Certified innovative group dental plans across multiple....

- Linthicum Heights, MD

Oversee the Provider Relations department including negotiations and administering organization policies and procedures. Six-figure salary, incentives, comprehensive benefits and full relocation packageOversee the Provider Relations department to ensure in compliance with company policies and standards, government laws, regulations and contracting standards.Develop, implement and monitor policies and procedures.Develop tactical plans to align strategies and technologies with future....

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