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- Austin, TX

Physician Our client delivers home based primary care, working with home health and hospice agencies to ensure patients receive continuity of care in the home environment. Our clients’ in-home physicians collaborate with agencies to establish in-home treatment plans and certify the need for services. Our client partners with home health agencies, collaborates with independent and assisted living communities, and works with skilled nursing facilities and hospitals to coordinate services and....

- Ft Lauderdale, FL

VP of Quality - Ft Lauderdale, FL Drive success in quality through process improvement activities for more efficient and streamlined workflow. VP is responsible for all activities related to NCQA Accreditation and HEDIS performance ensuring highest level of accreditation. OPPORTUNITY FOR EQUITY !!! SENIOR LEDAERSHIP role in a LARGE market. STRONG GROWTH potential- multiple product lines- GREAT relocation! -Manage all aspects of HEDIS improvement activities, including outreach, incentives, data


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....

- 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....

- 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....


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....


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,....


VP, Long Term Care Product - Health Plan- PA Design and own strategy and product for long term care for this new market. You will have an accomplished mentor and an opportunity to build out your own team here in PA. Highly visible role offers GENEROUS relocation- strong career potential. VP will own the responsibility for the Long Term Care (LTC) product in terms of design, implementation, operational structure and long term strategy. You will build and mentor a team and manage cross-....


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....


Director, Clinical Behavioral Health | Behavioral Health SME - TACOMA/SeattleTruly make a difference in healthcare in this community as part of this innovative health plan. KEY leader will develop a high performing, fully integrated medical management team, working in collaboration with the VP and peer Medical Management Directors. If you are a behavioral health SME who understands managed care, this may be THE opportunity to accelerate your career.-Director will oversee clinical functions in....


We are in search of a RN with 5 years clinical experience in Cardiovascular Surgery. Since this is a Manager role, the qualified candidate should have 3 years of management, Supervisory experience. Demonstrated clinical nursing leadership as a Charge/Senior RN. A BSN is required and it is a plus if you have a Master’s degree. Must have CVOR experience What is great about this role?Our client is offering relocation within the state of California and in addition to a robust 6 figure salary, you....


Chief Medical Director- Medical Review Position Purpose: Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the strategic plan, establishing the strategic vision and attendant policies and procedures. Serves as clinical advisor to and educator of medical management staff ensuring correct clinical judgment is applied to all medical management determinations.Oversees internal medical review....


Job Description:Conduct analysis, pricing and risk assessment to estimate financial outcomes. Provide expertise and technical support in matters related to the successful and financially sounds operations of the company’s health plan businessesApply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes.Negotiate capitation rates with State agencies.Review health plan experience and identify trendsAnalyze new business....


Job Description:Conduct analysis, pricing and risk assessment to estimate financial outcomes. Provide expertise and technical support in matters related to the successful and financially sounds operations of the company’s health plan businessesApply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes.Negotiate capitation rates with State agencies.Review health plan experience and identify trendsAnalyze new business....

- Hudson Valley, NY

Job descriptionChief Strategy OfficerCome be part of an organization devoted to the health of the people and communities that lies within the Hudson Valley region near the foothills of the Shawangunk Mountains and the Wallkill River.Reports To: Chief Executive Officer SUMMARY OF PROFESSIONAL FUNCTION The Chief Strategy Officer leads the development and execution of strategic initiatives in clinical and program areas implementing data driven quality improvement functions. The CSO communicates....


Excellent oppt'y for a Medical Technologist to work for a medical lab manufacturer and utilize their lab knowledge as a Technical Support Specialist. Will be instrumental during the installation process as a trainer, and documenting the lab procedures. Area to be covered is approx 150 mile radius of San Jose (Sacramento - Stockton - San Jose), and maybe a bit south of San Jose. Can reside almost anywhere is this area. Will also be involved with direct problem solving covering reagents, kits,....


Registered Nurse (RN) Home Infusion Clinical Sales Liaison As part of the sales team working closely with the Sales Account Executive and the Regional Sales Manager the goal is to grow the business by recognizing opportunities to expand relationships with existing referral sources and partner with the medical community to understand their patient’s needs for a safe and smooth transition home. Support and assist physicians, social workers, discharge planners and other referral sources to....


Registered Nurse (RN) Home Infusion Clinical Sales Liaison As part of the sales team working closely with the Sales Account Executive and the Regional Sales Manager the goal is to grow the business by recognizing opportunities to expand relationships with existing referral sources and partner with the medical community to understand their patient’s needs for a safe and smooth transition home. Support and assist physicians, social workers, discharge planners and other referral sources to....

- Coeur d Alene, ID

Magnificent setting in Northwest US, northern Idaho is a paradise for both summer and winter sports and is known for its quality of life, fresh air, friendly people and low cost of living. A number of national recreation areas as well as national and state parks are nearby. The city is within easy access of several colleges and universities which host a wide variety of year-long academic and cultural activities. This is a well established, highly reputable medical reference lab, independent....

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