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....SVP of Health Services | Executive Leader - Health Plan - Chicago HIGHLY VISIBLE opportunity working closely with the CEO. GENEROUS RELO- 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. - Administer and....

- Tacoma, WA
new job!

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....

- Milwaukee, WI
new job!

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
new job!

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....

- Pittsburgh or Harrisburgh, PA
new job!

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....

- Appleton or Eau Claire, WI
new job!

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....

- Appleton, WI
new job!

Medical Management Trainer – Appleton, WI Innovative national health plan! Newly created role will provide hands on training to clinical staff in Medical Management – RN’s and social workers. Great opportunity to influence quality of care for this underserved population. · Develop and conduct clinical educational classes/course · Develop, conduct and ensure maintenance of Case Management (CM) education · Conduct interqual training for CM staff · Conduct training to ensure proper inpatient....

- Appleton/Fox Valley, WI
new job!

Training Auditor (Clinical)Be part of a NEW team! You will be responsible for developing and conducting a variety of training programs and auditing tools for the medical managemnet team. You will provide insight to the Managers on areas of improvement and growth needed for the staff. GREAT growth opportunities and generous benefits!Conduct training needs analyses to determine specific training needs for clinical staff Identify, select, or develop appropriate training programs, including the....


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....

- Chicago, IL
new job!

Job description Looking for a Change Agent/Managed Care experience/RN License/Familiar with Provider/Payor side/ Company doubling/Rapid Growth/ Medicaid & Fostercare ProductReporting to the Plan President, the VP Medical Management will perform duties to direct and coordinate the medical management, quality improvement and credentialing functions for the assigned health plan based on, and in support of the company’s strategic plan; establishing the strategic vision and attendant policies....


Our client, is the world leader in eye tracking and speech generating devices - products that help individuals with speech and motor impairments live a richer and more independent life. If you want to work with meaningful products and solve interesting problems, this might be the right company for you! Our client is located in Pittsburgh. They offer their full-time employees a generous benefits package including health/dental/vision, 401K with company match, paid vacations, 10 paid holidays,....

- Outside of Wichita, KS
new job!

TITLE: Director of Pharmacy LOCATION: KS Are you interested in making a difference? Are you looking for a facility that is interested in candidates that want to grow professionally but have not been given the opportunity? Would you like to work in a facility that serves several counties and can offer small town living with lots of outdoor activities to create a work life balance and be within distance of a larger city? Then this could be an opportunity for you. SUMMARY: Directs and coordinates

- East of Columbus, OH
new job!

TITLE: Lab Manager over Phlebotomy LOCATION: East of Columbus, Ohio Are you considering a career change? Looking for a smaller community(25K population), that offers a low cost of living(18% lower than US average) and plenty of activities in the area but is within an hour of a large city. If so, an opportunity to work with an integrated health care system based in east central Ohio is looking for someone to join their team. The system is a not-for-profit and has over 300 physicians and....


Job description Looking for a Change Agent/Managed Care experience/RN License/Familiar with Provider/Payor side/ Company doubling/Rapid Growth/ Medicaid & Fostercare ProductReporting to the Plan President, the VP Medical Management will perform duties to direct and coordinate the medical management, quality improvement and credentialing functions for the assigned health plan based on, and in support of the company’s strategic plan; establishing the strategic vision and attendant policies....

- Sacramento, CA

Job descriptionPosition Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Reports to Chief Medical Director. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental....


Job description Overview Under the general guidance of the Assistant Vice President of Strategic Planning, provide strategic and operational leadership to the oncology department, Medical and Radiation Oncology, providing leadership of physicians, individual employees and work teams to achieve defined goals, objectives and outcomes in the areas of service, quality, finance, engagement and growth and providing for the efficient management of department resources to achieve goals and....


Our firm is in search of a RN, LVN/ LPN with case management experience. This position is focused on improving health outcomes, increased patient engagement in self-care, and improve coordination and health care delivery through our client’s Accountable Care Organizations (ACOs). This is a company who is an advocate on promoting from within….if you are looking for a long term opportunity and one that offers room for advancement, read on… Our client is specifically looking for a candidate who....

- Kansas City, MO

This is a 60 year old manufacturing and distribution company that is the perfect fit for someone looking to get out of the corporate grind. The company has an impeccable reputation in their industry and are looking for candidates who value quality. The Senior Production Planner is responsible for managing all material related Planning activities needed to meet clinical, commercial, and process development manufacturing requirements. Responsibilities include, but are not limited to, the....


Attorneys who specialize in the Stark Law... Stark Law effects the physician self-referral prohibition, commonly known as the Stark law, is a complex set of regulations that has constantly expanded since its initial publication in 1995. At that time, Stark only applied to clinical laboratory services. Now, Stark applies to a large number of services (referred to as the “Designated Health Services” or “DHS”) as well as virtually any financial relationship between a physician and the entity....

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