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Are you a Nurse Practitioner with a strong background in Surgical Services? Especially as it relates to Trauma cases? If yes, we want to speak with you! There are TWO openings. Perhaps you have a colleague, like you, who would also be interested. Please be sure to share our posting with those who are qualified. Our client facility is located centrally of Chicago, Detroit, Indianapolis and 3 miles from Michigan State Line. This is a college community experiencing economic growth and offers....


Executive Director Private Home Care, Bergen County NJ Position Description: The Executive Director will lead and direct all service delivery operations for Company in the Region. He/she will have oversight of all facets of service delivery to clients with a continual focus on process improvement, customer service, and improving the employee and client experience. He/she will be a key contributor with senior management in ongoing efforts to differentiate and innovate services provided. He/she....

- San Franscisco, CA

Manages a large unit or multiple units providing ambulatory services. Ensures staff provides high quality, accessible, cost effective care, and patient focused services to members across the continuum, which comply with local, state, and federal requirements. Develops and maintains clinical practice standards, budgets, and staff development. Essential Functions: - Manages the operations of a large unit or multiple units. Ensures Assistants and staff provide the highest quality of care and are....

- San Francisco, CA

Promotes professional development through the application of principles of adult learning in broad-based program development. Leveraging expertise in electronic medical record responsible for identifying, prioritizing,& evaluating, the educational & professional development needs of a clinical area;develops & delivers clinical educational programs, including specialty training, new graduate/hire training, continuing education for staff,& training for upgrades & changes.....


Provides in-depth clinical expertise in a defined area of nursing practice (eg., pediatrics, oncology, adult medicine). Develops and ensures quality standards for nursing practice for a specific patient population. Provides advanced clinical practice education, consultation, research and administration. Essential Responsibilities:Establishes and monitors care standards and makes recommendations for changes in area of clinical practice. Collaborates with nursing staff in assessing patient,....


Manages the delivery of nursing services and safe patient care within assigned department and across the continuum of care. Manages the delivery of services that add value and are integrated with nursing standards of practice, service priorities and performance/outcome measures, as well as with strategic, business and organizational goals/objectives. Essential Functions: - Manages on a 24 hour basis the delivery of nursing services and safe patient care which meet or exceed cost, quality, and....


Manages activities of the unit(s), monitors quality, service and utilization standards. Supervises the day to day shift activities. Essential Functions: - Manages the units day to day clinical operations including practice standards, staffing, payroll, budgets, fiscal management, and quality improvement. Ensures the highest quality of care is provided and is in compliance with federal, state, and local regulatory requirements and established departmental policies and procedures. - Develops and


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/Wenatchee, WA

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....

- 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....


Director, Finance – Health Plan – Chicago area Excellent mentor – unlimited career growth- newly expanding team…these are just a few reasons to consider a career with this national organization. Reporting to the SVP, the Director will oversee all activities of the business unit’s finance department and aid in formulating and administering organization financial policies and procedures. · Monitor business processes and systems to assure integrity in information and systems · Oversee preparation


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....


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....

- Appleton or Eau Claire, WI

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/Fox Valley, WI

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....


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....

- Chicago, IL

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....


Vice President, Actuarial Services & Risk Management (Medicare) Job descriptionPosition Purpose: Provide expertise and actuarial support to ensure efficient and effective operations of the commercial product lines.Develop actuarial pricing models for commercial and Exchange products to calculate the required premium levels in the open enrollment environment.Deliver pricing models that reflect the impact of ACA structural rating rules and develop various scenarios to identify pricing....


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....

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