Health Business
Job Openings

• Bio-Pharmaceutical Company, Data Manager/Senior Systems Analyst
• Confidential Government Programs Health Plan, VP- Network Services
• Lumen Legal, PBM Contract Attorneys and Paralegals
• Confidential Publicly Traded Regional Health Plan, Controller
• INSPIRIS, Director of Clinical Administration
• CoxHealth, Vice President, Managed Care
• Catalyst Rx, Executive Director, Clinical Operations
• Catalyst Rx, Clinical Manager, Specialty Program
• Confidential Revenue Cycle Management Firm, Chief Financial Officer
• Confidential Health Care Claims Payor, Chief Information Officer
• Confidential Health Care Company, Claims Business Analyst
• Confidential, Health & Welfare Financial Business Manager
• Confidential, Health & Welfare Medical Manager
• Blue Shield of California, Director of Pharmacy Benefit & Claims Administration
• BlueCross and BlueShield of Tennessee, Quality Assurance Lead - PHA
• Coram, Inc., Collections Manager
• Coram, Inc., Regional Director of Managed Care - North Central Region
• Coram, Inc., Territory Manager
• Confidential Employee Services Organization, National Vice President of Sales
• Confidential, Director of Health and Productivity Research
• Catalyst Rx, Staff Pharmacist
• Aetna Insurance, Inside Sales Manager
• Strategy, Policy and Consulting Firm, Head of State Health Care/Medicaid Consulting
• Confidential, Chief Financial Officer
• Confidential - Medicaid Health Plan, Chief Medical Officer
  
• Midwest Orthopaedics at RUSH, Director of Physical Therapy
• Confidential Managed Health Care Company,
  Pharmacy Director
• Confidential Managed Health Care Company, Director of Network Development & Management
• Confidential Managed Health Care Company, Director of Government Contracts
• Confidential Managed Health Care Company, Director of Quality Improvement
• Gordian/PHA, Implementation Account Manager
• Blue Shield of California, Medical Director, Network Medical Management
• Health Right, Inc., Chief Executive Officer
• Confidential - Health Plan, Medical Trend Analyst
• Medica Health Plans, Reimbursement Specialist
• WellPoint, Inc., Regulatory Compliance Manager
• WellPoint, Inc., Process Improvement Consultant
• Confidential Not-for-Profit Health Plan, Director of Product Development
• California Association of Health Plans, President and Chief Executive Officer
• Liberty Mutual, RN Nurse Case Manager
• BlueCross and BlueShield of Tennessee, Biostatistical Research Analyst
• US Medical Management, Chief Compliance Officer
• Blue Shield of California, Chief Medical Officer
• Confidential Ancillary Health Products Company,
  Senior Vice President of Sales
• Medica Health Plans, Medicare Sales Team Leader
• North Shore-LIJ Health System, Corporate Compliance Director
• Catalyst Rx, Pharmacy Manager - Retail
• CIGNA, Financial Analysis Specialist
• Blue Cross Plan, Director of Pharmacy
  
• Blue Cross Blue Shield of Tennessee, Associate Accreditation Analyst
• Kelly Healthcare Resources, HIM Manager
• Confidential Company, HEDIS Specialist/Client Account Manager
• Physicians United Plan, Senior Provider Contractor and Network Development Professionals
  
• Physicians United Plan, Provider Contracting Specialist and Network Development Professionals
  
• Physicians United Plan, Provider Relations Representative and Network Development Professionals
  
• Schering Plough, Regional Director
• The Burchfield Group, Vice President of Business Development
  
• Mount Sinai Medical Center, Reimbursement Manager
• Confidential Health Care Services Organization, V. P. of Marketing/CMO
• Quality Health Solutions, Health Coach
• Health Care Services Network, VP & General Manager Cancer Care Management
  
• Hill-Rom Holdings, Inc., Clinical Excellence Manager
  
• Community First Health Plans, Supervisor, Health Services Resolution
  
• Albert Einstein Medical Center, RN - Quality Improvement Manager - Heart and Vascular Institute
  

POSITION SUMMARY

• The Data Manager/Senior Systems Analyst is responsible for providing Level 2 and 3 support for Oracle support systems as well as application maintenance and performance analysis. The person will be responsible for testing new functionality, making necessary recommendations to enhance performance tuning to enterprise database servers and supported applications and as well as database redundancy, backup, and recovery.
  

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Provide level 2 and 3 applications support for Oracle and associated applications across the enterprise. This includes but is not limited to:
  
  • Oracle Clinical
    
  • Oracle Thesaurus Management System
    
  • Oracle Adverse Event Reporting System
    
  • eDocCompliance 2004
    
  • LabVantage Sapphire Laboratory Information Management System
    
  • Commvault Qinetix Backup and Recovery
    
    • Capable of managing dynamic changes with in the environment as they relate to change management, patch and security application, system updates and upgrades.
      
    • Provide and support data migrations to and from internal and external systems.
      
    • Maintain Title 21 Part 11 company compliance
      
    • Provide documentation support as it relates to the maintenance of systems with Title 21 Part 11 company compliance.
      
    • Responsible for establishing and enforcement of database and data integration standards and guidelines in order to ensure database and data integration conformity across the enterprise.
      
    • Demonstrate strong project management skills.
      
    • Provide excellent customer service and delivery of technological services.
      
    • Provide key database and application redundancy, backup, and recovery methods.
      
    • Ability to manage and prioritize multiple projects simultaneously to meet management mandated timelines.
      
    • Proven ability to manage vendor relationships.
      
    • Experience with Microsoft SQL 2005 and 2008 a plus
      
      

QUALIFICATIONS AND REQUIREMENTS

• Bachelor's degree or equivalent in computer science or related field.
  
• 5 or more years experience as a Senior Oracle database administrator
  
• 3 or more years experience in the Oracle Pharmaceutical Applications Suite
  
• Excellent oral and written communication skills
  
• Successful candidate must demonstrate experience in the following areas:
  
  • Installation and configuration of Oracle databases and database infrastructure
    
  • General Database Administration and Support
    
  • Relational Database Modeling and Data Integration Design
    
  • Database and Application Performance Tuning
    
  • Database and Data Integration Documentation, Testing and Validation
    
  • Functional and Technical Evaluation of Products and Database Upgrades and patches
    
  • Database Backup and Recovery
    
  • Change Management
    
  • Disaster Recovery Planning
    
  • Post-implementation Support
    
  • Commvault Qinetix
    
    

KEY PERFORMANCE MEASURES

• Maintain up times in excess of 99.6%
  
• Customer satisfaction in excess of 80% enterprise wide
  
• Maintain Title 21 Part 11 compliance
  
• Good communication within the IT organization
  
• Successful involvement in management mandated projects
  
• Timely completion of assigned project responsibilities
  
  

OTHER INFORMATION ABOUT THIS POSITION

• Reports directly to VP of Information Technology
  
• Estimated percentage of travel: 20% or less
  
  Must have the following experience:
  Oracle Clinical
  Oracle Thesaurus Management System
  Backup and Recovery
  Excellent communication - oral/written
  Pharmaceutical Industry experience

Nice to have experience:
eDoc Compliance 2004
LIMS

Resumes should be submitted to bsona@execu-search.com

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Our client is a rapidly growing, high quality government programs health plan company with expanding operations throughout the country. We are seeking a dynamic managed care executive to take over the management of the network services functions for the company in its flagship health plan in the Northeast.

The position has responsibility for the development, contracting and maintenance of provider networks of all kinds including large and small hospitals, PCP’s, specialty physicians and ancillary services of all kinds; provider relations and network operations. It is a mission critical position that will be integral to the continued growth of the plan and the company, as it expands in its regional area quite quickly.

The best candidates will have 10+ years minimum of senior health plan leadership with heavy experience in state of the art contracting, network development, provider relations and network operations; great leadership and negotiating skills, financial acumen and a total understanding of government programs primarily in the senior services area. Top compensation plan includes base salary, cash bonus program, equity program, executive benefits and corporate relocation package. Very high growth opportunity, lots more to do.

Contact in complete confidence: Marc Gouran, President, Solomon-Page Group at mgouran@spges.com

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Marshall Koll & Associates has been retained by a publicly traded regional health plan in the Pacific Northwest to assist in the recruitment of a Controller.

Our Client's product offerings include Medicare Advantage plans, commercial plans, individual plans and administrative services to individuals and businesses throughout the region. They have almost 50K covered lives and revenues in excess of $220M.

The Position reports to the CFO, is responsible for eight employees in accounting, financial reporting and operations, internal controls, regulatory filings, budget and forecasting.

The location is an energetic Pacific Northwest city with a fast-growing population, a scenic setting, year-round recreational activities and growing economy and offers premier skiing, hiking, fishing, camping, rock climbing, and championship golf, among many other outdoor activities, in an ideal climate of warm days and cool nights.

An extremely competitive compensation/relocation package is available.

For additional information, please contact:
Neill Marshall
Managing Partner
Marshall Koll & Associates
820 S. MacArthur Suite #105-303
Coppell, TX 75019
NeillM@MarshallKoll.com

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Position Summary

Responsible for provider credentialing, risk management, quality improvement and provider training functions at the corporate level, as well as facilitating compliance of individual markets with NCQA standards for delegated health plan functions, including complex case management. Responsible for organizing and maintaining corporate clinical policies and procedures. May also be called upon to assist in new market/product implementations.

Responsibilities

• Develops, maintains and manages corporate NCQA-compliant credentialing policies and procedures for INSPIRIS clinicians. This includes initial credentialing of a potential new clinician employee prior to hiring, as well as NCQA-mandated periodic re-credentialing of current staff.
  
• Provides direction and assistance to market-level resources responsible for credentialing when the credentialing function has been delegated by a health plan to an INSPIRIS market entity.
  
• Is the business owner of the credentialing software package and setup
  
• Develops, maintains and manages corporate assistance with government, health plan and facility credentialing/privileging of INSPIRIS providers and market entities.
  
• Develops, maintains and manages corporate clinical risk management policies and procedures, including the release of medical records upon authorized request.
  
• Develops, maintains and manages the corporate quality improvement program.
  
• Provides direction and assistance to market-level resources responsible for quality improvement programs when such programs are a component of functions delegated by a health plan to an INSPIRIS market entity.
  
• Provides direction and assistance to market-level resources responsible for other functions delegated by health plans to an INSPIRIS market entity, including complex case management.
  
• Develops, maintains, and manages provider training policies, procedures and curriculum.
  
• Develops, maintains, and manages corporate clinical policies and procedures.
  

Qualifications

• Clinical background, such as (but not limited to) registered nurse, rehabilitation or respiratory therapist, or social worker.
  A minimum of 5 years experience with a health plan, hospital or capitated physician organization in relevant areas, such as credentialing, risk management, quality improvement, and/or education.
  
• A minimum of 2 years experience in a leadership role within a healthcare organization in a relevant area (as above).
  
• Experience with the accreditation process (NCQA, URAC, JCAHO, or other).
  
• Proficient PC skills, including use of Microsoft Outlook and Office applications.
• Strong project management skills.
• Excellent interpersonal, verbal and written communication skills.
• Ability to interact effectively with clinicians and all levels of the organization.
  

Please contact Kerry Lanier at (888) 489-4151 or careers@inspiris.com

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CoxHealth, a Top 100 Integrated Health Care Network, headquartered in Springfield, Missouri invites applications for qualified individuals for the position of Vice President, Managed Care. Witt/Kieffer has been retained by CoxHealth to conduct this search.

CoxHealth is a four-hospital system with 9200 employees, more than 800 licensed beds, and with more than 50 physician clinics in the region. CoxHealth Network, the managed care operation, has net revenue of $350 million.

A degree in Business, Finance, Management or healthcare is required. A Masters degree in Business Administration or Health Care Administration is preferred or the equivalent in experience. Seven to ten years of managed care contracting and managed care strategy development experience in progressively responsible positions in health care or health plan environment is a must. Knowledge of federal and state regulations and anti-trust is useful. An understanding of NCQA and URAC credentialing guidelines is helpful. Experience working with the employers and broker community is important.

Nominations, referrals, and expressions of interest (including cover letter and resume) should be submitted confidentially to: CoxHealthVPMC@wittkieffer.com. Items which cannot be submitted electronically may be sent to Stephen J. Kratz or Shirley Cox Harty, c/o Witt/Kieffer, 3414 Peachtree Road, Suite 352, Atlanta, GA 30326, or faxed to (404) 261-1371. Inquiries may be directed by phone to 404-233-1370.

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SUMMARY:

Oversees and provides corporate support for clinical operations and ensures all departmental goals and objectives are met.

ESSENTIAL FUNCTIONS:

• Oversees and assists with research, development, and maintenance of all utilization management criteria and clinical program creation for the book of business.
• Researches drug pipeline and determine financial impact to book of business.
• Determines ROI for all clinical programs.
• Ensures all clinical programs adhere to guidelines set by formulary management, sales/marketing, pricing and other relevant corporate departments.
• Oversees the enhancement and maintenance of all existing clinical programs.
• Ensures all clinical programs/activities comply with URAC accreditation policies.
• Ensures all Catalyst Rx formularies are maintained, updated and properly documented.
• Ensures all clinical program enhancements and updates are documented within the benefit design system and on all applicable web-enabled areas.
• Oversees Catalyst Rx P&T Committee.
• Provide ongoing physician and member education program enhancements.
• Facilitates and oversees all functions of the Drug Utilization Committee.
• Oversees management of the specialty drug management program.
• Ensures all KPIs and Quality Improvement Plans are documented and appropriate targets are met.
• Acts as clinical team representative at all KPI and Quality Improvement Committee meetings.
• Provides sales and marketing support, as needed.
• Exhibits compliant and ethical behavior in the performance of job responsibilities, including complying with all applicable federal and state laws and regulations, HealthExtras Code of Conduct, Business Ethics Policies and Procedures and other policies and procedures applicable to position. Actively participates in HealthExtras Compliance and Ethics Program, including attending annual compliance and ethics training and reporting suspected violations of the law or HealthExtras policies and procedures via HealthExtras Procedures for Reporting Incidents of Possible Improper Employment Practices, Misconduct, or Improper Financial/Accounting Practices.
• Follows all policies and procedures related to job.
• Performs other duties as assigned to meet corporate objectives.
• Some travel may be required.

QUALIFICATIONS:

Bachelor's Degree in Pharmacy or doctorate of Pharmacy (PharmD), current state pharmacy license and 5+ years pharmacy practice experience (PBM/managed care environment preferred) and/or experience developing clinical programs, presenting at various committee meetings, and performing drug utilization analyses. Management experience and strong communication, interpersonal, presentation, customer service, and computer skills required.

Send your resume to Lisa Calla-Russ at lcallaruss@catalystrx.com

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SUMMARY:

Responsible for performing all functions for the Catalyst Rx Specialty Drug Management Program.

ESSENTIAL FUNCTIONS:

• Answers questions and provides information to internal team on all specialty drug/formulary related issues.
• Assists with implementation of new specialty programs for new or existing clients
• Develops custom specialty options for clients
• Creates and implements new specialty utilization management criteria
• Maintains various vendor formulary and pricing lists
• Maintains all specialty lists on internal channels.
• Creates and maintains client specific and standard specialty reporting package
• Develop outcomes or savings reports for presentation to clients
• Creates and updates training program and provides training to internal personnel on all aspects of the specialty program.
• Assist with all sales requirements as it relates to specialty.
• Acts as liaison between clients and specialty vendors.
• Exhibits compliant and ethical behavior in the performance of job responsibilities, including complying with all applicable federal and state laws and regulations, HealthExtras Code of Conduct, Business Ethics Policies and Procedures and other policies and procedures applicable to position. Actively participates in HealthExtras Compliance and Ethics Program, including attending annual compliance and ethics training and reporting suspected violations of the law or HealthExtras policies and procedures via HealthExtras Procedures for Reporting Incidents of Possible Improper Employment Practices, Misconduct, or Improper Financial/Accounting Practices.
• Follows all policies and procedures related to job.
• Performs other duties as assigned to meet corporate objectives.
• Some travel may be required.

QUALIFICATIONS:

Bachelor's Degree in Pharmacy or doctorate of Pharmacy (PharmD), current state pharmacy license and 3+ years pharmacy practice experience (PBM/managed care environment preferred) and/or experience in specialty drug management. Strong communication, interpersonal, presentation, customer service, and computer skills required.

Send your resume to Lisa Calla-Russ at lcallaruss@catalystrx.com

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Reporting to and partnering with the Chief Operating Officer (COO), the Chief Financial Officer (CFO) will set financial policy and direction while also being an active participant in, and driver of, the organization’s strategy. They will also work together on strategy, financial policy and performance, seeking approval where appropriate. He/she will lead all financial administration, business planning, and budgeting. The CFO will be responsible for developing and monitoring business metrics and analytics to measure operational and client performance, identify trends, manage the overall cost structure and assist in identifying innovative techniques for improving profitability.

Requirements:

• Must have 10 years or more of senior management, including at least five years as a CFO with particular emphasis on bad debt collections for a $20 mm to $50 mm revenue cycle company serving the provider (hospital and physician group) markets.
  
• 5-10 years of collections “agency” experience in a growth oriented and for- profit company serving the provider market.
  Must bring a detailed understanding of call center operations for Collections including the supporting technologies.
  Strong understanding of corporate finance with the ability to analyze operational and financial data to determine trends and issues.
  Must have an in depth understanding of revenue cycle management in the provider market.
  
• Bachelors Degree required with a preference for a Master in Business Administration, CPA is highly preferred.

Candidates MUST have the above credentials to be considered. Please email resumes to:

Lee Calhoon, President
Lee Calhoon & Co (www.leecalhoon.com)
leecalhoon@aol.com

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THE CLIENT:

Our client provides healthcare claims payors with a comprehensive suite of clinical services designed to maximize claims efficiencies. Relocation required to a western state.

DUTIES & RESPONSIBILITIES:

Responsibility for the selection, acquisition, development, installation, maintenance and support of all information technology including corporate databases and client services implementation oversight. Monitors and reports on the performance of the IT portfolio including actual vs. expected results, budgets and project duration. Develops and maintains the systems architecture, defining standards and protocols for data exchange, communications, software and interconnection of network information systems. Reviews all hardware and software acquisition and maintenance contracts, soliciting involvement and participation of other management team members as appropriate. Develops and maintains corporate policies and standards aimed at maximizing effectiveness and minimizing costs related to the acquisition, implementation and operation of IT systems. Responsible for the development, implementation and ongoing support/maintenance of our clients Disaster Recovery Plan to ensure timely and effective restoration of data and IT services in the event of a disaster.

REQUIREMENT / QUALIFICATIONS:

Bachelor of Science is required, Masters preferred.

Candidates MUST have 10+ years experience preferred in the health care insurance industry with strong presentation skills, customer (internal/external) problem diagnostics and solution design, tactical scheduling, strong contract knowledge, strong HIPAA compliance knowledge, with at least 5 of those years in a management position.

Hands-on application design and development experience with web-based database driven applications and connectivity to backend systems, with strong skills with products such as Oracle 10g and related utilities/tools, PL/SQL, Toad, Visual FoxPro, ASP, ASP.NET, HTML, VBScript, JavaScript, Style Sheets.

Demonstrated experience in the use of metrics to assist in increasing overall efficiency of the development process with demonstrable knowledge of healthcare claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-9, CPT and HCPCS.

Contact Lee Calhoon at leecalhoon@aol.com

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Job description:

• 5 years of experience in Business analysis.
• Strong understanding of SDLC and RUP project methodologies.
• Experience in gathering, writing detailed requirements of user needs, business impacts, and system functionality.
• Should have experience in Trizetto facets and claims.
• Experience in setting up claims applications.
• Healthcare background.
• Payer experience is a must.
• Good communication and documentation skills

Send in your resumes to mahendra.rao@emids.com

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Assists with the Management of the Health and Welfare Department performing Claims Administration, Case Management, Appeals, Cobra, Workers Compensation, Subrogation, TPA Services, Audit, Life Insurance, Total Disability, and other auxiliary services for a national Taft-Hartley Fund. Manages and develops supervisory/management staff and 70+ bargaining unit employees. Carries out all Health & Welfare Financial Business Manager responsibilities in accordance with the Fund office’s policies and applicable laws.

Staff Management

• Assists with managing associates and facilitates the development of talents of less experienced associates through coaching and mentoring.
  
• Collaborates with Director with personnel hiring decisions
  Assists with management of personnel and report to
• Director and HR any infractions against the Fund personnel policies.
  
• Meet with Stewards/HR as needed to discuss personnel issues when Director is not available
  
• Assist with the management of supervisors and area specialists
  
• Assists with the management of bargaining unit staff according to the union contract.
  
• Assists with communication to H&W staff.

Claims

• Works with other department Managers/Supervisor under the direction of the Director with administration of claims according to the Plan Documents as directed by the Board of Trustees
  
• Responsible for continual monitoring and understanding of national and regional healthcare trends, standards, and forecasted issues that may affect BNF.
  
• Responsible for non-ppo price contracting with providers
  
• Identify potential risks associated with healthcare fraud and abuse corporate wide and perform in-depth studies and investigations on identified issues and/or entities.
  
• Manage extensive data mining, analysis and trending of aggregate data. Conduct professional or hospital bill and records audit to determine compliance with relevant billing and processing guidelines, and to identify opportunities for fraud and abuse prevention and control.
  
• Collaborate and assist with Claims Examiner Processing Units and other internal areas on matters concerning fraud and abuse. Recommend possible interventions for loss control and risk avoidance based on outcomes of the investigation. Coordinate with the concerned unit or designated Fund representative regarding possible corrective actions.
  
• Review and recommend to Director acceptance of contract language for select group of insurance contracts and/or amendments.
  
• Oversight of verifying that H&W is using the updated and correct codes for processing – recommends to Director reference materials needed to accomplish
  
• Works with Managers/Supervisors to collect information needed to ensure the staff has the appropriate tools to process claims correctly.
  
• Assist the Director when needed with the Performance Guarantee Reporting to Vendors according to contract.

Operations

• Under the direction of the Director works with H&W vendors and partners to include:
  
  • Relationship/Communication
    
  • Renewal review
    
  • New Contract review
    
  • Day to day business needs
    
  • Performance guarantee review/communication
    
  • Conflict Resolution
    
  • HIPAA
    
  • Medical review of proposed settlement agreements for Subrogation and WC.
    
• Assists with the development and implementation of H&W claims processing policies and procedures along with plan document language recommendations
  
• Coordinates with other managers on needed information to conduct investigations
  
• Refers and discusses complex case or cases that do not meet established criteria and guidelines with a final recommendation to the Director
  Initiate random and incidental employee audits to ensure compliance with office guidelines and Plan provisions
  
• Oversee the Workers Compensation area
  
• Oversee the Subrogation area
  
• Oversee the Overpayment area
  
• Assists the manager with analysis and verification of the job descriptions for both bargaining and non-bargaining unit staff. Reporting of differences to manager and/or HR.
  
• Recommends to Director seating and arrangement of the floor for operational efficiency.
  
• Assists Director with IT:
  
  • Departmental management of system changes to process claims
    
  • Departmental management of plan changes
    
  • Departmental management of special projects
    
  • Construction of RFP proposals
    
  • RFP review and analysis of return RFP’s
    
  • Recommends H&W IT needs operationally
    
    

Audit

• Assists Director in ensuring that the proper audit processes are in place to include:
  • Overpays
  • Large claims
  • PPO/NONPPO
  • Claims at certain financial levels
  • Medical necessity
  • Authorizations
  • Numerous other criteria
  • Project leader for outside audit

Fund Wide Responsibilities:

• Participates on cross functional teams, and promotes teamwork within the Funds office. Interfaces with internal Human Resources, Information Technology and Accounting, and PMO.
  
• Work with internal Compliance Attorney to oversee legal compliance and Appeals
  
• Serve as a resource for internal clients requiring assistance with internal and external benefits resources i.e. special projects.
  
• Apply knowledge regarding the major providers and vendors who operate in the market areas. Keep knowledge current as market changes. Be willing to share knowledge with other departments.
• Assists with presentation of project proposals and deliverables to senior management, Plan Design Committee, as needed
• Assists with data collection, verification, and communication to administration, and others as needed.
• Other duties as assigned

Education and/or Experience

• Bachelors Degree in Business Administration preferred
• 7 plus years experience in health insurance operations at a managers level, preferably in financial management to include fraud and abuse, knowledge of standards for healthcare within the medical community
• background knowledge in various healthcare services and health insurance operations preferably in fraud and abuse along with provider contracting experience
• general knowledge of health/dental benefit coverage
• knowledge of medical policies and internal benefit administration and reimbursement guidelines
• strong analytical, critical thinking, organizational and judgment skills, detail oriented, effective problem solving and decision making skills; ability to work on multiple projects
• Knowledge of Word and Excel; effective oral and written communications skills; or, any combination of education/experience that would provide an equivalent background.

Background Screening is required. We are an "EOE" Equal Opportunity Employer.

Apply to careers@bnf-kc.com

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The Medical Manager (Licensed RN) assists with the Management of the Health and Welfare Department performing claims administration, Case Management, Appeals, Cobra, Workers Compensation, Subrogation, TPA Services, Audit, Life Insurance, Total Disability, and other auxiliary services for a national Taft-Hartley Fund. Manages and develops supervisory/management staff and 70+ bargaining unit employees. Carries out all Health & Welfare Medical Manager responsibilities in accordance with the Fund office’s policies and applicable laws.

Staff Management

• Assists with managing associates and facilitates the development of talents of less experienced associates through coaching and mentoring.
  
• Collaborates with Director with personnel hiring decisions
  Assists with management of personnel and report to
• Director and HR any infractions against the Fund personnel policies.
  
• Helps to identify personnel that might have greater potential than currently utilizing – performance measurement.
  
• Meet with Stewards/HR as needed to discuss personnel issues when appropriate or Director is not available
  
• Assist with the management of supervisors and area specialists
  
• Assists with the management of bargaining unit staff according to the union contract.
  
• Assists with communication to H&W staff.
  

Claims

• Works with Supervisors/Techs under the direction of the Director with administration of claims according to the Plan Documents as directed by the Board of Trustees
  Responsible for continual monitoring and understanding of national and regional healthcare trends, standards, and forecasted issues that may affect BNF.
  
• Works with Supervisors as to maintain acceptable timeframes and accuracy of claims processing with regards to medical necessity under the direction of the Director
  
• Day to day oversight for ensuring that participants are receiving the correct benefits
  
• Works with the manager to ensure the benefit plan is being adjudicated correctly
  
• Review and recommend to Director the acceptance of contract language for select group of insurance contracts and/or amendments.
  
• Oversight of verifying that H&W is using the updated and correct codes for processing – recommends to Director reference materials needed to accomplish
  
• Works with supervisors to collect information needed to ensure the staff has the appropriate tools to process claims correctly.
  
• Assist the Director when needed with the Performance Guarantee Reporting to Vendors according to contract.

Operations

• Under the direction of the manager works with H&W vendors and partners to include:
  
• Relationship/Communication
  
• Renewal review
  
• New Contract review
  
• Day to day business needs
  
• Performance guarantee review/communication
  
• Conflict Resolution
  
• HIPAA
  
• Medical review of proposed settlement agreements for Subrogation and WC.
  
• Helps to lead the development and implementation of H&W claims processing policies and procedures along with plan document language recommendations
  
• Coordinates UR and Authorization process with third party vendors
  
• Refers and discusses complex case or cases that do not meet established criteria and guidelines
  
• Receive and resolve escalated provider and/or participant complaints received via telephone or letter due to claims denied for medical necessity, no auth, etc.
  Identify potential risks associated with healthcare fraud and abuse Fund wide and perform in-depth studies and clinical investigations on identified issues and/or entities.
  
• Initiate random and incidental employee audits to ensure compliance with office guidelines and Plan provisions
  
• Oversee and mentor H&W staff on medical necessity, medical terminology, etc
  
• Oversee the Appeals staff for the department
  
• Oversee the Case Mgt staff for the department
  
• Oversee the Transplant staff for the department
  
• Assists the Director with analysis and verification of the job descriptions for both bargaining and non-bargaining unit staff. Reporting of differences to Director and/or HR.
  
• Recommends to Director seating and arrangement of the floor for operational efficiency.
  
• Assists Director with IT:
  
  • Departmental management of system changes to process claims
    
  • Departmental management of plan changes
    
  • Departmental management of special projects
    
  • Construction of RFP proposals
    
  • RFP review and analysis of return RFP’s
    
  • Recommends H&W IT needs operationally
    

Audit

• Assists management in ensuring that the proper audit processes are in place to include:
  • Overpays
  • Large claims
  • PPO/NONPPO
  • Claims at certain dollar amounts 15K,25K,50K,100K
  • Medical necessity
  • Authorizations
  • Numerous other criteria
  • Project leader for outside audit
    
    
• Works with Director with building a Financial Business Unit

Fund Wide Responsibilities:

• Participates on cross functional teams, and promotes teamwork within the Funds office. Interfaces with internal Human Resources, Information Technology and Accounting, and PMO.
  
• Work with internal Compliance Attorney to oversee legal compliance and Appeals
  Serve as a resource for internal clients requiring assistance with internal and external benefits resources i.e. special projects.
  
• Apply knowledge regarding the major providers and vendors who operate in the market areas. Keep knowledge current as market changes. Be willing to share knowledge with other departments.
• Assists with presentation of project proposals and deliverables to senior management, Plan Design Committee, as needed
• Assists with data collection, verification, and communication to administration, and others as needed.
• Other duties as assigned

Education and/or Experience

Bachelor Degree in Nursing or higher
5-7 years experience in health insurance operations and management, preferably in Medical Review
Knowledge of standards for healthcare within the medical community

Background knowledge in various healthcare services and health insurance operations, preferably in Medical Review/Management

General knowledge of health/dental benefit coverage
Knowledge of medical policies and internal benefit administration and reimbursement guidelines

Strong analytical, critical thinking, organizational and judgment skills, detail oriented, effective problem solving and decision making skills; ability to work on multiple projects

Knowledge of Word and Excel; effective oral and written communications skills; or, any combination of education/experience that would provide an equivalent background.

Background Screening is required. We are an "EOE" Equal Opportunity Employer.

Apply to careers@bnf-kc.com

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• Develop operations for the pharmacy benefit by providing the following key services: Benefit Administration, Rx Claims Processing, Rx Call Center and Prior Authorization Operations. This includes the commercial and Medicare Part D lines of business.
• Provide oversight for benefit coding and implementation for all product lines including benefit analysis, design and build
• Provide oversight for claims adjudication based on pharmacy benefit design and formulary rules
  
• Provide oversight for vendor contract negotiations and performance.
  
• Provide oversight for Pharmacy Benefit Management’s call centers that support pharmacies, physicians, members & Blue Shield of California internal constituents.
  
• Provide oversight and strategic leadership and ensuring optimal processes are in place for delivering the above services.
  
  Candidate Profile and Requirements:
  
  
• Seven years related managed care experience and/or training.
  
• Knowledge of health benefit plan design and health related insurance products.
  
• Strong understanding of claims and benefits administration including experience managing claims processing and operations.
  
• Demonstrated ability to drive to quality decisions with staff, peers and executives.
  
• Strong building and managing partnership skills.
  
• Vendor management and contract is experience is a plus.
  
• Experience re-engineering processes to increase effectiveness and efficiency.
  
• Exhibits a can do attitude and solution oriented approach to issues.
  
• Experience managing on-line claims processing edits.
  
  Please apply online through our company website via http://www.blueshieldca.com/careers and search for job # 28267.
  
  Any questions or inquiries, please email: eric.principe@blueshieldca.com
  
  

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The QA Lead - PHA will lead the QA process. This position is the subject matter expert in Automation testing for the .Net platform.

Job Duties & Responsibilities:

• Coordinate the day-to-day operations of Quality Control (QC) methods for our suite of software solutions.
  
• Lead and manage all activities of a Quality Assurance (QA) test team, including but not limited to, test planning, execution, regression testing, functional test automation, performance testing and UAT.
  
• Ensure the quality of the solution by participating in all phases of the solution development lifecycle.
  
• Work closely with team members in distributed locations to coordinate planning and execution of Quality Assurance activities.
  
• Identify, select, and proliferate automated product testing tools
  
• Lead a team of QA Analysts
  
• Develops, maintains, and oversees the QA schedule and QA feedback loop
  
• Drives the development, implementation, and maintenance of all policies, procedures, and standards pertaining to Software Quality Assurance, ensuring their conformance with industry-defined best practices
  
• Responsible for adherence to all Quality Assurance policies, procedures, and standards

Education:

• BS/BA degree required
  
• Advanced degree (Masters or MBA) preferred
  

Experience:

• 8-10 years of technical QA experience
  
• 3 years of test lead experience in a .Net environment
  
• Experience building or rebuilding/revamping QA department utilizing formal QA methodologies, standards, best practices, processes and/or procedures
  
• Experience working on Health Care software projects including EMR / EHR systems
  
• Experience with the iCoaching model and software systems
  
• Test Automation and Implementation experience
  
• Experience with Quick Test Pro, other Mercury Products, or other .Net automated test tools
  
• Experience working with a .NET Development environment
  
• Proven track record for successfully leading a QA team
  
  

Skills/Certifications:

• Certified Quality Manager and/or Certified Software Test Engineer
  
• Possess strong knowledge of formal development methodologies (SDLC, UML, SCRUM, RUP, XP).
  
• Project Management experience required

Please apply via our career site at: https://www.bcbst.com/about/careers/openings/

Position Closes: June 6, 2009

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Description

Coram Specialty Infusion Service an Apria Company is currently seeking an experienced, skilled Manager for our Medical Collections Dept. You will be responsible for directly managing a staff of 30; interfacing with customers, outside agents and managers; create reports, develop policies & procedures for dept. to increase production and results. Candidate should have a proven record of success in Healthcare collections. 5 years general Healthcare collections experience plus a minimum of 3 years managerial experience with a minimum of 3 staff directly reporting to you. Thorough knowledge of the collections process; capable multitasking, thinking outside of the box, dealing quickly with the demands of the job in a fast paced environment. Must be proficient with Excel, and other collection software; able to interface with all levels of staff & management; very articulate and customer service oriented. Knowledge of the pharmaceutical or Healthcare industries is preferred. Able to multi- task & prioritize, excellent organizational & follow up skills.

Oversees and ensures the collection of reimbursement within a reasonable time frame through the leadership and motivation of the reimbursement team and the establishment and maintenance of good working relationship with payers, patients and co-workers as necessary to accomplish company/department goals and objectives.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Oversees the accounts receivable and collections process to ensure adherence to standards and performance to goals.

2. Trouble shoots field operations and makes appropriate recommendations for the improvement of performance.

3. Provides procedural direction/training to all PFSC members.

4. Supervises staff, including interviewing, hiring, coaching, counseling, training and performance evaluations.

5. Assists in setting budgets, establishing reserves, approving expenditures, monitoring bad debt and contractual allowances and departmental progress against financial goals.

6. Performs other duties as assigned.

Requirements

5+ years managerial experience in Healthcare collections. Strong verbal and written skills, ability to multitask, respond quickly and accurately, detail oriented and responsive. Must be highly organized able to think quickly in a very fast paced environment. Bachelors degree required, Masters degree preferred.

For further inquiries please contact Jeff Battinus at jeff.battinus@coramhc.com or via telephone at 877-CoramHc

We conduct drug and background checks in our recruiting/hiring processes. AA/EOE, M/F/D/V

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Develops and implements strategies to improve managed care net revenue, payer and business relations, and cash collections for a major specialty infusion market. Core responsibilities include renegotiating and evaluating managed care agreements, interfacing with payers on contract compliance and payment issues, and developing an annual managed care market plan. Responsible for performing on-going monitoring of financial performance of the managed care agreements and the development of strong working relationships with payers and business partners in various markets.

Region Includes; Kansas, Minnesota, North Dakota, South Dakota, and Nebraska. This position can be based in Kansas, Minnesota, or Missouri and requires approximately 40% travel.

Requirements

Bachelors degree required postgraduate degree or advanced clinical degree preferred.

5+ years in a specialty services sales environment, and prior management experience. A strong understanding of contracting processes. Must exhibit a strong ability and experience working with senior level medical directors and large audience presentations. Payer experienced, specialty pharmacy, sales management, and operations experience required. Experience working with local insurance contracting, driving revenue and gross profit margins, among selling specialty programs.

Coram is a national provider of home infusion services and specialty pharmacy distribution with more than 80 branch locations across the country. Our nurses, pharmacists, dietitians and other clinical staff are known in the industry for providing a superior level of personalized care to thousands of home and infusion suite IV patients every day, including those with complex therapy needs.

For further inquiries please contact Jeff Battinus at jeff.battinus@coramhc.com or via telephone at 877-CoramHc

Because Coram believes in providing a safe work environment, we conduct drug and background checks in our recruiting/hiring processes. AA/EOE, M/F/D/V

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Exercises total net revenue and profit objectives for assigned territory with the primary goal of bringing in new business to increase overall market share. Span accounts include, but are not limited to, hospitals, physicians and home health agencies controlled by one or more competitors or those referral sources with minimal account penetration. Acts as a primary liaison between the account and the branch and demonstrates the highest level of customer satisfaction for internal and external customers.

Performs all phases of sales activities for assigned territory, including analysis of client needs and sales opportunities, presentations of; services, pricing and negotiating of the partnership agreements and servicing of the account and follow-up as necessary. Coordinates all team-selling efforts at the branch and corporate levels. Develops, implements and manages business opportunity contractual agreements. Acts as a change agent to foster favorable core therapy admits growth month over month and year over year.

Minimum Qualifications

Three to five years of measured success and progressively more responsible or expansive sales experience preferable in the healthcare industry. Customer service skills, medical background, working knowledge of insurance rules and regulations, accounting and operational skills. Excellent leadership and interpersonal skills.

Coram is a national provider of home infusion services and specialty pharmacy distribution with more than 80 branch locations across the country. Our nurses, pharmacists, dietitians and other clinical staff are known in the industry for providing a superior level of personalized care to thousands of home and infusion suite IV patients every day, including those with complex therapy needs.

For further inquiries please contact Jeff Battinus at jeff.battinus@coramhc.com or via telephone at 877-CoramHc

Because Coram believes in providing a safe work environment, we conduct drug and background checks in our recruiting/hiring processes. AA/EOE, M/F/D/V

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The Howard Group, a nationally recognized executive search firm specializing in Employee Benefits and Healthcare Services has been retained to conduct a search for a National Vice President of Sales. The position can be based anywhere, though there is a preference to have the position located in the eastern half of the United States.

This National Vice President of Sales position is with an organization that is transitioning from an employee benefits administrator to an Employee Services Organization, or "ESO". ESO is a new term and business model in the general employee benefits industry. This new business model offers a unique value proposition. This company will offer a single source solution for the full range of employment issues, from recruitment through employment termination. Services will broadly include payroll, a host of insurance-related services, health and wellness programs, retirement and financial planning.

The qualified candidate for this position will need to understand and embrace the vision of this business model, and then comprehend its far-reaching business potential. The client is looking for a producing sales management executive that earnestly wants a career opportunity "to do something significant". This is an opportunity to be a part of something new and innovative…a real "impact" role.

The client requires that interested candidates have a self-starting drive to succeed, documented through past experience, and the full understanding that s/he will be selling a concept and value proposition virtually unseen before in the market.

This innovative approach stems from existing limitations that currently exist in the "employee benefits" industry through service providers that have failed to respond to an employers needs regarding employees issues and concerns. This organization is providing a solution to that market demand through a full and comprehensive array of products and services that will actually work to lower employer costs. As an ESO, this organization will be able to function pro-actively to curb an employers overall costs of hiring and retaining an employee. This innovative model is not just a distinguishing factor, but will be a clear and compelling competitive advantage that other service providers in the "supply chain" will have difficulty competing with.

Currently, this organization has revenues exceeding $17M, and has strong brand recognition. It is an industry leader as evidenced by the following:

• All customer service calls are answered in less than 30 seconds
  
• Client retention of 94%
  
• 95% of all employee health claims are paid in 10 days or less
  
• Financial payment accuracy of 99.4%
  As for the position, the selected candidate will sell, and assist in the sales, of all products and services offered by the organization. Sales will be procured through initial direct contact with employers of 250 to 10,000 employees. Should a consultant or broker be involved, they will be brought into the process.

The selected candidate will manage 2 sales professionals and subsequently hire and build out a national sales force of additional regional sales professionals.

The qualified candidate will have several years of successful sales, and sales management experience with documented achievements. The candidate's experience can come from a variety of venues, including HRIS, Business Process Outsourcing, Human Resource Outsourcing, payroll, employee benefits, as well as the general healthcare services industry. Experience selling directly to F1000 organizations would be preferred and very beneficial.

For immediate consideration, qualified individuals are encouraged to promptly email their resume in complete confidence to Brian Howard, Principal at: bhoward@thehowardgroup.com.

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The health care business of our client provides insights -- information, benchmarks and analysis -- that enable organizations to manage costs, improve performance and enhance the quality of health care.

We are seeking a Research Director with experience managing a research business and strong analytical/applied research skills (senior health economist) in the following areas: health promotion/disease prevention, worksite health promotion, health and productivity management, financial impact analysis, applied research, and program evaluation. The individual should be familiar with the worksite health promotion literature and possess excellent writing, presentation, organizational, and interpersonal skills. The candidate should be able to review, interpret and synthesize quantitative and qualitative data from government and private sector funded research projects. Oversight of client and project management function, including supervision of staff and management of departmental financial performance including sales, contract revenue, margin, and department profitability. Main focus is to generate revenue and retain customer relationships focused on research projects.

Responsibilities
Support business development process by actively leading and/or participating in proposal development efforts.

• Provide strategic account management for major accounts.
  
• Recruit and retain a highly talented staff including researchers, programmers, analysts, economists, and/or statisticians as required.
  
• Ensure client satisfaction by anticipating needs and meeting those needs by establishing baseline information on client business strategy and objectives, and information needs, and then updating this at least annually.
  
• Manage financial performance by ensuring financial goals for all assigned department(s) are maintained (revenue and income), contract margins meet annual plan targets, and that the receivables (billed and unbilled) for all contracts are collected to meet annual targets.
  
• Drive resolution of client issues through company's senior management, data management, and product development infrastructure.

Qualifications

• Graduate level education, Ph.D., MBA, MPHA, or equivalent education and experience.
  
• 10+ years of experience in healthcare information consulting/research, with client contact at senior levels and demonstrated business development skills.
  
• 10+ years of managerial experience managing multiple employees and major accounts.
  
• Current or prior responsibility must have included annual revenue accountability in excess of $1 million.
  
• Proven history of ability to capture the attention and respect of key decision makers in the client environment.
  
• Possess a superior understanding of both new business development and consulting methodology.
  
• Expertise with business organizations coupled with academic research experience is desirable.
  
• Experience in managing professional researchers, multiple projects, budgets, and customer relationships is required.
  
• Excellent presentation and communication skills.

Contact Patrick Fromelt at pat.fromelt@cbigrecruiting.com.

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The staff pharmacist will be tasked with all Pharmacy related duties in the continual support of the pharmacy manager and Catalyst Rx's client Sandia.

ESSENTIAL FUNCTIONS:

• Provide concurrent drug utilization reviews to counsel patient medication therapies and monitor for drug-drug and drug-disease interactions and adverse effects.
  
• Provide medication counseling and education of durable medical devices specific to diabetic patient population
  
• Supports services at the Pharmacy operations level for improved patient communications and education.
  
• Provide and administer vaccinations to patients
  
• Supports the maintenance of consistent inventory levels reflective of Plan approved formulary
  
• Maintaining compound and dispensed prescriptions in a manner that complies with all legal requirements, including OBRA'90.
  
• Transferring prescriptions as necessary.
  
• Handling inbound/outbound physician calls to validate and fulfill prescription information.
  
• Provide accurate and consistent service levels focusing on timely and accurate medication distribution.
  
• Coordinate with other departments and team members within Catalyst Rx to provide maximum level of service.
  
• Ensuring adherence and compliance with all state and federal regulations pertaining to the Pharmacy.
  
• Supports the management and training of pharmacy technicians
  
• Oversees Pharmacy Student/Externship Program
  
• Exhibits compliant and ethical behavior in the performance of job responsibilities, including complying with all applicable federal and state laws and regulations, HealthExtras Code of Conduct, Business Ethics Policies and Procedures and other policies and procedures applicable to position
  
• Actively participates in HealthExtras Compliance and Ethics Program, including attending annual compliance and ethics training and reporting suspected violations of the law or HealthExtras policies and procedures via HealthExtras Procedures for Reporting Incidents of Possible Improper Employment Practices, Misconduct, or Improper Financial/Accounting Practices
  
• Performing other duties, as necessary, to meet the objectives of Catalyst Rx.

QUALIFICATIONS:

• Current New Mexico Pharmacy License
  
• Doctorate of Pharmacy (PharmD)
  
• 2-5 years of Retail Pharmacy Experience
  
• Excellent interpersonal and customer service communication skills
  
• Supervisory experience
  
• Able to work a flexible schedule

Send your resume to Lisa Calla-Russ at lcallaruss@catalystrx.com

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JOB GROUP SUMMARY
These are the professionals who help us build our business in the national accounts, middle markets, small group markets, distribution channel, group insurance and specialty products areas. Their goal is to meet customer needs and help them make better decisions and about their health care and health care spending.

EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

• Licensed Life and Health Producer is required (or must be obtained within 60 days)

FUNCTIONAL WORK EXPERIENCES

• Sales: Management: > 25 employees

REQUIRED SKILLS

• Address individual performance gaps against expected results throughout the performance period
  
• Analyze business unit performance requirements to determine individual expectations for each employee
  
• Coach employees to maximize performance
  
• Create book of business strategies
  
• Develop individual metrics that align to department business plans
  
• Monitor employee performance against critical behaviors and results expected throughout the performance period

DESIRED SKILLS

• Analyze and critically evaluate specific growth opportunities
  
• Create target market strategies
  
• Develop competitive positioning strategy to position Aetna favorably against local competitors
  
• Identify and anticipate legislative, industry and competitors changes and trends
  
• Identify market opportunities to expand Aetna's current business capabilities (organic growth)

POSITION SUMMARY
Aetna Consumer Segment has an exciting opportunity for a proven, successful sales professional to develop and manage an organization that engages in consultative telephone sales for Medicare products. The Manager must have experience selling Medicare products, developing a sales organization, coaching and mentoring agents, tracking results, and identifying opportunities for improvement. This is a new department and the Manager will be responsible for the design and implementation of business processes and supporting technology.

ADDITIONAL JOB INFORMATION
The successful candidate will be responsible for working with both licensed agents on effectively communicating the features and benefits of Aetna s Medicare products, with a goal of achieving targeted close ratio. This includes coaching the team on sales closing techniques and prospect management; developing, communicating and monitoring individual and team performance standards; identifying training needs; and developing agents to be able to effectively position Aetna products. The role requires the ability to continuously strive for superior customer service levels through ongoing mentoring and training. The Manager must exhibit an appropriate level of initiative and sound business judgment to address and elevate issues hindering the ability to effectively close sales. The Manager must create a team environment that motivates employees, manages performance, recognizes achievement and develops staff. In addition, the Manager will work closely with other areas within Aetna to understand product features and marketing campaigns to effectively align messaging. The position is located in Pittsburgh, PA.

We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.

For immediate consideration, click here.

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Our client is a top strategy and policy consulting firm that is seeking a new leader for its vibrant State Healthcare and Medicaid Consulting Unit. This unit does a wide variety of policy, analytical and strategy consulting assignments for state governments and agencies in Medicaid, SCHIP and many other health policy/human services programs on a national basis. The best candidates will have a minimum five-ten years of consulting leadership experience; or state or federal policy leadership experience; or senior executive leadership of a large complex Medicaid health plan. Additional requirements include strong management skills, analytical background, a track record of thought leadership in this space, success as a "rain-maker" and a top academic background with a preference for advanced degrees like MBA's, MPH's, PhD's. etc. Top company, great compensation, flexible location and a very high growth opportunity.

Please contact Marc Gouran, Solomon-Page Group at mgouran@spges.com All inquires are always completely confidential.

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The Chief Financial Officer will be responsible for all financial reporting and forecasting, budget preparation, risk, and financial/internal audits. BA Degree in business administration, accounting, or finance Master's degree preferred; C.P.A. designation preferred. Exp. with Medicaid, Manage Care Operations, Government Contracting, FAR regulations Expert knowledge of Microsoft Office Suite

We offer a competitive compensation and benefits package. Send resume and salary requirements to:

hr1_jobs@yahoo.com

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The Chief Medical Officer will lead all medical and behavioral health management and clinical quality related activities for all product lines and health plans. This position will be responsible for utilization management, quality improvement, accreditation, credentialing, pharmacy, health services, behavioral health services, and medical policy. The CMO reports directly to the CEO.

POSITION DUTIES AND RESPONSIBILITIES

• Lead the development, implementation, and monitoring of medical policies and procedures for clinical programs and processes, as they relate to overall delivery of health care to members
  
• Develop and implement strategic plans for medical management and ensure that appropriate metrics are designed and implemented for comprehensive program assessment
  
• Guide staff in the design and interpretation of medical policy and assessment
  
• Provide leadership and guidance on medical cost containment savings initiatives and disease protocol practices
  
• Collaborate with senior management and actively participate in the design and execution of strategic goals, objectives, and organizational plans
  
• Provide oversight for quality improvement and compliance activities, as related to accreditation, and state and federal regulations
  
• Establish, monitor, and control corporate medical and behavioral health quality standards
  
• Lead the development and oversight of clinical practice studies and plan analysis to identify best practices associated with improved health outcomes
  
• Analyze and interpret utilization management and clinical program data with the goal of ensuring processes meet and exceed organizational goals
  
• Participate in committees (e.g. quality, credentialing, pharmacy and therapeutics, etc.) which require medical expertise and are required by regulation and/or accreditation
  
• Lead the activities of all medical management staff
  
• Serve as medical liaison within the community as it relates to developing and managing physician relations

MINIMUM EDUCATION REQUIREMENTS

• Graduate as a Medical Doctor from an accredited college of medicine
  
• MBA, MPH, or related post-graduate degree preferred.

SPECIAL KNOWLEDGE AND/OR SKILLS

• Excellent written and verbal communication skills
  
• Demonstrated excellent clinical skills
  
• Ability to design and use information systems and analytics to drive data analysis that improves the quality and efficiency of care delivery
  
• Knowledge of federal and state Medicaid regulations, guidelines, and standards
  
• Comprehensive knowledge of accrediting organizations, such as NCQA
  
• Comprehensive knowledge of InterQual protocols, HEDIS, and other quality measures

WORK BACKGROUND/EXPERIENCE

• At least 5 years of direct clinical experience in a clinical practice area
  
• At least 2-3 years of progressively responsible medical management experience in a managed care setting preferred
  
• Current unrestricted licensure as an M.D. in the Commonwealth of Virginia, or the ability to obtain unrestricted licensure within a reasonable period of time
  
• Experience with Medicaid programs strongly preferred
  
• Board certification or eligibility in area of clinical practice preferred

Contact: Geoff Fitzgerald for additional information

508.563.2732 gf@fitzsearch.com

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Midwest Orthopaedics at RUSH (MOR), a nationally known, ranked and recognized academic orthopedic practice in Chicago, seeks a hands-on, experienced physical therapy executive to fill the role of Director of Physical Therapy. This is a newly developed position that will be integrally involved with the development of a new physical therapy center that is part of a comprehensive Orthopaedic Ambulatory Building that MOR is developing on the grounds of and in partnership with RUMC. Midwest Orthopaedics at RUSH is a very subspecialized orthopedic private practice that is affiliated with Rush University Medical Center and also partners with professional athletic teams,(Chicago White Sox and Chicago Bulls), collegiate athletic teams (DePaul University) as well as various high school and club programs of every level.

The ideal candidate will be a currently licensed and practicing physical therapist with experience opening new facilities, promoting and developing the latest and most effective techniques and approaches and will have significant workers compensation and clinic management experience. The Director of PT will have full P&L responsibility for this service line within MOR, will be expected to effectively market the program and to partner with RUMC's physical therapy, health sciences, orthopedic departments and academic and research functions. This person will be primarily responsible for making MOR Therapy a best-in-class clinical service. The anticipated start date for this position will be 3rd quarter of 2009.

Qualifications:
MS in health sciences; successful completion of therapist program and a minimum of eight years progressively responsible positions in physical therapy field; minimum of five years management experience.

Please indicate salary requirements. Responses without salary requirements will not be considered. Please respond via email at dirofpt@rushortho.com. No phone calls please.

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Headway Corporate Resources has been entrusted to fill a Pharmacy Director position with our client, a leader in the healthcare industry.

As the Pharmacy Director, you will be responsible for monitoring drug utilization patterns for the company and assisting in the development, implementation and supervision of programs to promote cost-effective pharmacotherapy.

Additional Duties & Responsibilities will include:

• Reviews member, physician, pharmacy and drug utilization reports.
• Identifies trends affecting the pharmacy budget.
• Requests, reviews and summarizes ad hoc reports as required.
• Provides regular summaries of activities to Medical Director.
• Participates in the evaluation of new drug products.
• Develops criteria for reviewing prior authorization requests.
• Assists in the review of prior authorization requests and summarize the approval and denial of such requests.
• Selects and maintains appropriate pharmacy reference resources. Researches and references drug therapy related questions. Performs audits as required of patient charts, provider sites and pharmacies.
• Perform other duties as assigned.

Requirements:

• Bachelor degree in Pharmacy required. (Doctorate in Pharmacy (PharmD) and completion of ASHP-approved residency program are preferred)
• Licensed to practice Pharmacy in the State of Mississippi.
• Minimum of two years in the health care industry or equivalent experience in managed care and/or retail pharmacy is preferred. Prior experience in the oversight of projects and managing people is desired.
• Prior work experience with vendors, outside contacts and other health care professionals to accomplish responsibilities.
• Knowledge of computer data extracting methods. Strong knowledge of pharmacological management of chronic disease states. Ability to accurately assess and retrieve information from database. Ability to accurately input information from database.
• Must be free of sanctions from Medicaid or any other government program and without restrictions that would affect job performance.

Salary is commensurate with experience!

For immediate consideration, please forward your CV w/salary requirements to dcoley@headwaycorp.com or apply online at www.headwaycorp.com/jobs

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Headway Corporate Resources has been entrusted to fill a Director of Network Development & Management position with our client, a leader in the healthcare industry.

As the Director of Network Development & Management, you will plan, organize, staff, and coordinate the activities of the Provider Services & Contracting department. You will work with management to develop and implement provider contracts and contracting strategies, recruit and train new providers, and maintain positive and productive relations with providers and their office personnel.

Additional Duties & Responsibilities will include:

• Develop and deploy strategic network planning tools to drive Provider Services & Contracting Strategy across the enterprise. Facilitate strategic planning and documentation of Medicare network management standards & processes.
  
• Work collaboratively with the Medicare plan team and functional business unit stakeholders to lead and/or support various Medicare provider services functions with an emphasis on developing and implementing standards and best practices sharing across the organization.
  
• Company matrix team environmental support including but not limited to New Markets Provider/Contract Support Services, PCRP & CSST resolution support, and National Contract Management support services.

Requirements:

• BA or BS Degree or commensurate/equivalent provider contract network development & management, and project management experience, in a managed healthcare setting. MA or MS preferred
• Preferred 10 years experience in managed healthcare administration
  
• Preferred 10 years experience in provider contract negotiations in a Medicare managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, group and hospital contracting, etc
  
• Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicare lines of business, including but not limited to; fee-for service, capitation and various forms of risk, ASO, etc.
• Extensive software skills & competencies are required, as well as Internet research abilities and strong communication skills.
  
• Must possess the ability to learn new healthcare information systems and applicable software programs
  
• Effective written and oral communication skills. Must be able to communicate comfortably and effectively with all levels of a healthcare organization, within both the corporate and regional market environments.

Salary is commensurate with experience!

For immediate consideration, please forward your CV w/salary requirements to dcoley@headwaycorp.com or apply online at www.headwaycorp.com/jobs

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Headway Corporate Resources has been entrusted to fill a Director of Government Contracts position with our client, a leader in the healthcare industry.

As the Director of Government Contracts, you will be responsible for the overall supervision of the Medicaid enrollment process, marketing/sales, provider/member assistance, as well as ensuring compliance with State Health department policies.

Additional Duties & Responsibilities will include:

• Oversees state Legislative activity.
  Primary contact for company's lobbyist. Serves as company's primary contact with government agencies liaison to Department of Social and Health Services and Health Care Authority.
  
• Participates in industry and government sponsored work groups to meet company's organizational goals and objectives

Requirements:

• Bachelor’s Degree in Business Administration, Healthcare or related field (or equivalent combination of education and experience)
  
• One year supervisory experience. Three years’ experience in a managed care environment.
  
• Knowledge of State Health Department mandated laws and rulings.
  
• Excellent interpersonal human relations skills.
  Comprehensive knowledge of Mississippi Medicaid policies and programs.
  
• Excellent written and oral communication skills.
  Ability to travel as needed.
  
• Technical knowledge of State/federal government health care regulatory environment required.

Salary is commensurate with experience!

For immediate consideration, please forward your CV w/salary requirements to dcoley@headwaycorp.com or apply online at www.headwaycorp.com/jobs

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Headway Corporate Resources has been entrusted to fill a Director of Quality Improvement position with our client, a leader in the healthcare industry.

As the Director of Quality Improvement, you will be responsible for the planning, developing and directing of Quality Improvement functions. Provide leadership, management and supervision of the Quality Improvement Department operations and staff. Ensure that the quality of healthcare services rendered meets or exceed professionally recognized community standards. Develop and implement measures and controls to achieve company’s goals.

Additional Duties & Responsibilities will include:

• Responsible for the design, development and implementation of the overall Quality Improvement Program.
  
• Accountable for timely program revisions to meet regulatory and accreditation agencies’ requirements.
  Analyze, update, and modify standard operating procedures and processes to continually improve QI Department services/operations.
  
• Assist in strategizing and facilitating various committee structures and functions to best address the QI process.
  Responsible for the coordination and completion of all QI activities required to meet NCQA accreditation standards.
  Initiates and coordinates the development of Practice Guidelines.
  
• Assist Quality Improvement staff in interpretation of Quality Improvement departmental policies, procedures and criteria for monitoring and tracking activities.
  
• Responsible for monitoring and evaluating staff performance.
  
• Develops strategies for special program participation and Quality Improvement. Develops systems for close coordination of QI related functions with departments whose activities are directly a part of the QI Program, including Credentialing.
  
• Responsible for annual budget preparation and its maintenance within allocated parameters.
  
• Communicates new state, federal and third party regulations and requirements to the staff. Acts as a liaison to regulatory agencies.
  
• Performs other duties as assigned.

Requirements:

• BSN/BS/BA Degree in Healthcare related field. Master’s Degree in Healthcare a PLUS!
  
• Quality Improvement experience - minimum 5 years;
• Managed Healthcare – minimum 5 years.
• Excellent knowledge of NCQA standards.
• Medicaid experience – minimum 2 years.
• Management Experience - minimum 5 years.
• Knowledge of applicable state, federal and third party regulations with special emphasis on Medi-Cal Managed Care.
• Excellent verbal and written communication skills.
• Proficiency with computer information systems and software.
• Strong analytical and problem solving skills.
• R.N with active licensure. Certification in Healthcare Quality by the Healthcare Quality Certification Board, or equivalent (preferred).

Salary is commensurate with experience!

For immediate consideration, please forward your CV w/salary requirements to dcoley@headwaycorp.com or apply online at www.headwaycorp.com/jobs

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The Implementation Account Manager will perform dual responsibilities' for both initial program implementations, subsequent implementations as well as overall account management duties. The Implementation Account Manager provides implementation oversight, account management and customer service to a designated portfolio of Gordian clients throughout the customer lifecycle by managing implementations, relationships and providing guidance and consultation toward optimizing the customer's health management programs.

Functions

• Manage implementation project plans and a cross-functional team toward meeting implementation goals
  
• Manage and anticipate client expectations in a consultative manner
  
• Key contact for communication with Gordian's book of business under supervision of the Director of Customer Care
  
• Maintain 80% client retention rate on assigned client(s), ensure client satisfaction and account profitability, determine compliance to product standards
  
• Develop solutions to issues that require use of creativity and unique approach for resolution
• Lead cross-functional team before and after implementation to ensure client expectations are met
• Effectively communicate with client, other Gordian departments and vendors to ensure quality delivery of customer service, to coordinate workflow and ensure timely resolution of issues
• Act as gatekeeper for determining trigger point of including key core team into process
• Develop and manage client-based budget post-implementation
  
• Provide Status and timing to the client and executive team
  
• Provide client with outcome management reporting and recommendations for current program enhancement to increase participation and assist in reaching client goals and objectives
• Monitor the pulse of the client and anticipate client needs in the future
  
• Maintain client database with updated programming information and account fees
  
• Ensure program compliance with company and HIPAA policies and procedures
  
• Keep current on population health management initiatives
  
• Contribute to department's education/training plans and continuous area development and growth
  
• Assist other Gordian departments in account closure (i.e. sales presentations, RFP, contract, etc.)
  
• Work with other Gordian departments to plan, implement, and fulfill services that meet participants' needs
  
• Play key role in training the department on reporting and the data warehouse
  
• Maintain consultative tools and resources
  
• Provide recommendations to account managers in preparations for client meetings
  
• Assist in development of strategies for at-risk clients
  
• Act as knowledge source and senior team consultant for account management
  
• Other duties as assigned by a Director of Account Management

Qualifications:

• Bachelor's degree in health related field or equivalent experience required (Master's preferred)
  
• At least 3 years experience in program implementations with proven results (PMP certified preferred)
  
• At least two years of both implementation and account management, consulting, or other related experience
  
• Proficient in MSOffice Products (for PC): Word, Excel, PowerPoint, Outlook and Project
  
• Excellent oral/written communication skills, proven management and analytical abilities, conflict management and resolution skills, program planning, implementation experience, and effective presentation skills
  
• Demonstrated skill in critical thinking, diplomacy, conflict management, and relationship building
  
• Concentrate on complex issues that require resolution management
  
• Highly developed communication skills, successfully demonstrated in effectively working with a wide a variety of people
  
• Organize and manage work to achieve results
  
• Track performance so that problems are detected or prevented
  
• Exhibit consistent commitment to continuous quality improvement
  
• Manage multiple priorities including relationships with peripheral business units/strategic partnerships at Gordian
  
• Demonstrate ability to organize and present to a group setting
  
• Ability to mentally and physically keep up with a very fast pace, tight deadlines, multiple demands, and occasional long hours
  
• Flexibility in regards to all aspects of job functions

Please apply via our career site at: https://www.bcbst.com/about/careers/openings/

Closes May 18, 2009

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Additionally, the Medical Director will review pre- and post-service requests and render decisions based on the evidence of coverage, medical necessity, Blue Shield of California medical policy, as well as legal and regulatory requirements. The Medical Director must feel comfortable in clinical conversations with Blue Shield providers. The position requires a medical degree (MD or DO) with 5+ years of active clinical practice in an adult-based primary care specialty (Internal Medicine or Family Practice).

Active recent hospital experience (within the past 5 years) and some experience (2+ years) in utilization management, case review, and/or quality improvement activities in a managed care setting are desirable.

Please apply by email: Eric Principe, eric.principe@blueshieldca.com

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Health Right, Inc., a NCQA accredited managed care organization and an affiliate of Unity Health Care - the largest non-profit provider of health care in the nation's capital and the fourth largest Federally Qualified Health Center in the country - is looking to identify a new Chief Executive Officer.

Candidates must be master's prepared and have a minimum of ten (10) years of executive level management experience in health care organizations, and/or health insurance companies. Candidates should possess a strong background and demonstrated success in managed care operations, as well as an in-depth knowledge of risk sharing, medical management, product diversification, and network development. A focus on quality and member satisfaction is very important, as is an ability to work collaboratively with internal and external stakeholders. Experience working with a Medicaid population is highly preferred, as is a thorough understanding of the regulatory environment applicable to MCOs. A full copy of the position specification document can be found here.

To apply for the CEO position, or to nominate an individual for consideration, please send (email preferred) a current resume with a cover letter describing your interest and experiences specifically applicable to this position to Witt/Kieffer, Health Right's executive search consultants at HealthRightCEO@wittkieffer.com. Confidential inquiries and questions concerning this search may be directed to Jennifer Bauer at 301/654-5070. All communications will be treated confidentially.

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Our client has been their state’s premier health care provider for over 50 years. Located in the Northwest, this plan has over 550,000 members enrolled in Managed Care, Medicare Supplement, Medicare Advantage and PPO products. As a result of growth, they are now looking to build their actuarial team by hiring a Medical Trend Analyst. This is a newly created role and the successful candidate will have the immediate opportunity to make an impact on the company. This person would report to the Vice President of Actuarial and Underwriting and would work closely with the medical management team and monitor trends. We are currently seeking an Associate, Fellow or Near Associate of the Society of Actuaries. This person must have prior health experience and be pursuing or have attained their Actuarial Designations.

Interested candidates, please contact Nida Osman at 1-800-466-1578, ext 433. or submit your resume to nosman@jacobsononline.com. The Jacobson Group.

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The Reimbursement Specialist is Medica's expert resource for implementing and communicating HIPAA approved code sets and industry recognized reimbursement methodologies and guidelines. Provides critical review and communication of UHG Reimbursement Policies, initiates the development of Medica-specific reimbursement policies and provides input during provider network contract negotiation. Interfaces with providers, as well as Medica medical directors and other internal and external customers, being a key stakeholder in complex claims issue resolution. Make recommendations to Medica through participation in the Reimbursement Policy Committee and Subcommittee, as well as the Facility Policy Workgroup to generate cost savings and facilitate accurate reimbursement to providers. Develops educational tools to meet the needs of key stakeholders including the Network Management Department, Reimbursement Policy Committee and Subcommittee, as well as the Facility Policy Workgroup. Supports the Coding Administrators, as needed, at various external State committee meetings working to ensure payer uniformity and national billing standard conformity in order to provide rational and defensible reimbursement policies.

Associates degree in Medical Records or Nursing and Coding certification (CPC, CPC-H, CCS or CCS-P) or the completion of such certification within one year of employment is preferred. Two-year RHIT or four-year RHIA medical records administration degree or equivalent experience in coding is preferred. 3+ years coding experience related to professional billing and diagnosis coding (CPT, HCPC, ICD 9 diagnosis codes) or hospital/facilities bill coding (UB92 revenue codes, DRGs, APCs and ICD 9 diagnosis and procedural codes); those having at least one of the 3+ years of experience in both professional and facilities coding are preferred. RN/LPN nursing degree/experience desirable. HMO and claims experience helpful.

The required candidate should have strong technical coding skills, related to professional billing and/or hospital/facilities billing. The candidate should have the ability to understand and empathize with the providers' needs, while working to achieve the health plan's business and financial goals as impacted by coding processes and procedures. The candidate should have the ability to relate to a wide variety of professionals, providing coding expertise for complex situations requiring in-depth problem solving skills, and high decision quality. The desired candidate must have strong business acumen and analytical abilities to review data and trends and work with the team to identify and implement effective solutions for Medica. Strong communication and presentation skills are also important for training and communicating with providers and internal staff as well as for coding articles written for communication bulletins distributed to providers.

Apply to www.medica.com job #9026.

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Evaluates, develops and implements policies and procedures related to MA, MA-PD and PDP compliance programs and applicable company standards - set forth by CMS. Ensures compliance with state and federal agencies by studying existing and new legislation; enforcing adherence to requirements and facilitating cross-functional teams to advise management on needed actions. Ensure File and Use Certification is obtained and maintained. Maintain compliance of printed materials by working with the Sales and Marketing department to understand and meet all federal and state regulations. Facilitates cross-functional teams to develop and implement processes consistent with regulatory requirements, and department's policies and procedures. Develops training materials and presentation of educational programs relating to Sales and Marketing Compliance. Responsible for managing regulatory compliance functions for a major business segment, including state regulatory compliance, communications compliance and policy language development. Primary duties may include, but are not limited to: Develops, implements and maintains formal compliance structure and computer and filing systems for compliance materials. Create the structure and processes necessary to manage filings and related activities. Manages process for drafting all policy language and reviews all written materials for compliance with state and federal regulations, as well as contractual requirements. May interact with legal department to review and evaluate required state regulatory filings. Other duties as assigned.

• Requires BA/BS, 5 years related experience; or any combination of education and experience which would provide an equivalent background.
  
• Requires mastery of contract and business writing and a proven ability to analyze and integrate highly technical information into action plans.
  
• Expert knowledge on the Medicare Managed Care Guidelines with particular focus on the sales and marketing guidelines.
  
• Minimum 5 years hands on Medicare experience.
  
• Knowledge and expertise navigating HPMS.
  
• AHIP certification or certifiable within the first 3 months of employment.
  
• Some travel required.

Please apply online through our company website via http://www.careersatwellpoint.com/ and search for job number 39007.

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• Requires a BA/BS degree in a related field, 5-8 years of related experience; or any combination of education and experience, which would provide an equivalent background.
  
• Certified Project Manger (CPM) preferred.
  
• Demonstrate ability to analyze existing and potential workflows, processes, supporting systems, and procedures and identifying improvements required.
  
• Excellent oral, written and interpersonal communication skills required.
  
• Strong analytical, organizational, planning, problem solving and project/decision facilitation skills required.
  
• Ability to travel maybe required.
  
• Subject-matter expertise on Medicare Managed Care guidelines is essential.
• Three or more years working within a health plan and within the Medicare Advantage administration highly preferred.

Please apply online through our company website via http://www.careersatwellpoint.com/ and search for job number 39003.

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The California Association of Health Plans (CAHP) is seeking a President and Chief Executive Officer. CAHP is the largest statewide health plan trade association that represents 39 health plans which provide coverage to more than 21 million Californians.

Responsible to the Board of Directors elected by the membership, the President and Chief Executive Officer serves as the primary advocate for the managed health care industry in California. He/she manages and supervises the operations of the Association and represents the Association with lawmakers, media, other organizations and the general public.

Qualified candidates will possess the following characteristics:

• Over ten years of senior-level experience in healthcare operations, association management, legislating, legislative advocacy, public administration, regulation, government relations, public affairs or trade or consumer advocacy. Experience working with a board of directors is strongly preferred.
• Knowledge of the health plan industry and the operations and management of HMOs. Understanding of health care in California is highly desirable; California experience a plus.
• Reputation for developing and maintaining relationships at the highest levels, including company executive management and elected/appointed officials.
• Track record in the development of public relations strategies. Effective spokesperson with the media and persuasive public speaker.
• Evidence of a management style that emphasizes accountability, collegiality, teamwork, participation and communication. Personal characteristics of honesty, integrity, good communication and interpersonal skills.

Meyer Consulting has been exclusively retained to conduct this search. Only qualified candidates need apply. For more information, please contact Jan Jordan, Meyer Consulting at cahp@meyerconsultinginc.com.

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Liberty Mutual, with over 41,000 employees in more than 900 offices, is known globally for "helping people live safer, more secure lives" every day. We are proud to have achieved a rank of 94 on the Fortune 500 list of largest U.S. corporations based on 2007 revenue, and of our place as the sixth-largest property and casualty insurer in the U.S. based on 2006 direct written premium.

Are you tired of working weekends, major holidays or rotating shifts? Are you looking for an opportunity to put your clinical nursing experience to work in a flexible environment for a Fortune 100 Company? If so, Liberty Mutual has the job for you.

In this office-based position, you will provide nurse case management services for workers compensation claims. Leveraging your nursing expertise, interpersonal skills, and problem-solving abilities, you will collaborate with physicians and other medical providers, patients, employers, and claims professionals to ensure effective service delivery.

Our standards are high. Our environment is fast-paced. Our pay-for-performance and rewards programs recognize those who help us keep our service promises, including “helping people live safer, more secure lives.” To achieve these goals, we need you to demonstrate:

• A high level of integrity;
• The ability to manage your performance independently;
• Excellent organizational skills;
• Proficiency with software applications such as MS Office (Excel, Word);
• Nurse case management skills including at least three years of relevant nursing experience, and a current registered nurse license in the state where the position is based and other assigned states as required by law. CCM, COHN, CRRN, or CDMS certification required. BSN is preferred
• Bilingual skills are a plus.

To apply, please go to our website at: www.libertymutual.com or contact Meredith at: Meredith.Imholt@Libertymutual.com

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(2 Positions Available)

The mission of the Medical Informatics Division (MI) is to support all BCBST business units by conducting research, and developing tools and processes that improve the outcomes, quality, access to, cost and utilization and management of health care to BCBST members. MI achieves this mission through health services and other types of research designed to (1) improve clinical practice, (2) improve BCBST's ability to provide access to and deliver high quality, high-value health care, and (3) provide policy makers with the ability to assess the impact of system changes on outcomes, quality, access, cost, and use of health care resources. The candidate chosen for this position will serve to support the mission of the MI division.

Primary Duties and Responsibilities:

• The incumbent will work closely with scientists and business unit staff to support the MI mission through the following major activities:
  
  · Provider Profiling
  · Network Evaluation
  · Transparency and Pay for Performance Programs
  · Clinical Program Evaluation
  · Research Studies
  · Population Assessment
  · Statistical Analysis
  · Outcomes Assessment
  · Report and Tool Development
  · Utilization and Cost Studies
  
  The incumbent will use their prior experience in the development and maintenance of the above-mentioned programs and activities. The candidate chosen will also be expected to keep up with latest research in these areas and apply these new techniques as appropriate.
  
  In addition, the selected candidate will conduct research and be involved in studies in the following major areas:
  1. Development and testing of outcomes measures addressing severity and risk adjustment, as well as general measurement issues; and strategies for improving outcome measures for patients and providers.
  2. Applied Research using Episode of Care Technology.
  3. The relationship between processes and outcomes of care, including timing of services.
  4. Evaluation of, and development of measures for, outcomes, effectiveness, and cost effectiveness of clinical preventive services for all ages.
  5. Analysis of the causes of variations in clinical practice and the use of health care technologies, including the clinical behaviors of primary care and specialty providers, provider training, patient characteristics and preferences, or other factors.
  6. Effects of information technology applications, such as computerized decision-support systems, on improving outcomes.
  7. Studies that use various external sources of data to assess the cost and utilization of health resources within the BCBST member base.
  8. Impact of the trends in health care prices, costs, and sources of payment for services on access, expenditures, and outcomes.
  9. Development of new and more effective ways to measure the range of health care costs and to organize and analyze data on costs by clinical condition, socio-demographic factors, site of care, and payment sources.
  10. Assessment of the determinants of access to care and strategies to improve access.
  The candidate is expected to work as a research leader with associate Bio-Statistical Analysts to design and carry out health-related research, and be able to present research findings and evaluation results to internal and external audiences on a frequent basis.

Qualifications

• Minimum acceptable qualifications include a bachelor's degree in a quantitative/research discipline and four or more years of research experience in a managed health care environment or an advanced degree in a quantitative/research discipline and two years of research experience
  
• Have experience in the application of modern statistical design and analysis techniques to health-related data
  
• Have a strong interest in statistical and research methodology
  
• Strong abilities in the use of SAS and other computational software for statistical analysis
  
• Have demonstrated oral and written skills as well as teamwork and leadership qualities

Please apply via our career site at:
https://www.bcbst.com/about/careers/openings/

Closes May 23, 2009

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Summary of Position:
The Chief Compliance Officer (CCO) will oversee the Corporate Compliance Department of USMM and act as staff to the CEO and Board of Directors. The successful candidate will serve as the primary point of contact and facilitator between all operational areas under the management of USMM to ensure compliance with federal, state and local regulatory requirements. The CCO will ensure that all employees are in compliance with the rules and regulations of regulatory agencies, that the corporation policies and procedures are being followed, and that the behavior of the organization and its employees meets the standards of the USMM Code of Conduct. The CCO will function as an independent and objective body that reviews and evaluates compliance or issues of concern within the organization. The CCO will conduct investigations into concerns/allegations and provide appropriate interventions when warranted then develop/implement corrective action plans for resolution of problematic issues. Guidance will be provided by the CCO on how to avoid or deal with similar situations in the future.

Full Time is preferable but a Part Time position may be considered. Some travel will be required.

Company Background and Mission:
US Medical Management (USMM) is the management company that oversees operations of a multi-state physician practice, independent diagnostic and radiology facility (IDTF), and a home health and hospice division.

The physician practice was incorporated over 13 years ago. USMM's main mission is to provide quality medical care to persons who are homebound, residing in an Assisted Living Facility or Adult Foster Care residence. Due to the skills of our highly trained providers, we help prevent unnecessary hospitalizations or admissions to nursing homes by coordinating treatment plans and options with the patients, family members, caregivers and/or other health care providers.

Duties and Responsibilities:
USMM follows the seven (7) recommended elements of the Office of the Inspector General (OIG) to ensure an effective compliance program. The CCO's duties will include, but are not limited to, following these recommended elements.

Knowledge of these recommended elements is crucial for this position.

Qualifications and Experience:

• Law enforcement background and/or governmental legal/regulatory experience is preferable
• Experience in outpatient healthcare compliance with demonstrated experience and leadership
  
• Familiarity of operational Compliance, QA, and HR issues
  
• A Bachelor's Degree, at minimum, is desired

Fax cover letter and resume to 248-324-0761 or email to hrjobs@visitingphysicians.com

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Blue Shield of California (BSC) has been a leading nonprofit provider of quality health insurance plans for 70 years, with a mission to ensure all Californians have access to high-quality health care at a reasonable price. Our 4,700 employees serve over 3.2 Million Californians.

The Chief Medical Officer (CMO) for the Healthcare Services organization will be integral in the realization of BSC's mission, by providing leadership and direction for health management and clinical quality improvement strategies, providing greater value to its members through pharmacy and medical management, and optimally functioning management systems. This position based in San Francisco, will work with the Business Units to maximize the value and minimize the market risk of medical management by coordinating and aligning the strategies of benefit design, provider contracting, utilization review, medical policy and claims payment. The CMO is key member of the Senior Staff and provides input, strategic direction and serves as a clinical interface spokesperson in a wide variety of venues for BSC.

Requirements:
The ideal candidate will have 15 years of experience in a managed care setting; and proven experience with medical management, medical policy, quality, accreditation, pharmacy and program management.

Qualifications:
Medical degree (MD or DO) from an accredited institution is required; completion of a Masters Degree program in Health Admin or Business Admin, or Certificate in Healthcare Management is preferred. Board certification is required as is an unrestricted California State Medical license.

For more information about this search, contact: Tara Gear, Executive Recruiter, Blue Shield of California at tara.gear@blueshieldca.com or (415) 229-6437. Send resumes as a Word document attachment. Referrals requested.

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Our client, a very progressive, $1 billion+ company in the ancillary health products space, located in the Northeast, is seeking a new Senior Vice President of Sales. This position will oversee all sales, sales operations and account management activities managing a large, dynamic, complex national sales organization. The total staff is more than 50 people in locations around the country. The best candidates will have a minimum of ten+ years in senior sales management at the executive level on a regional or national basis for a health plan, health insurer, ancillary product company, DM company or related company; a measurable, documented track record of proven success; exposure to payers, government programs and large commercial customers; a sales training and development focus; good financial and communication skills; high energy and innovative thinking. This position offers a top compensation plan, executive benefits, full relocation package and high growth potential.

For more information or to apply please contact Marc Gouran, President, Solomon-Page Group in complete confidence at: mgouran@spges.com.

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The Medicare Sales Team Leader is responsible for optimizing CHA (Center for Healthy Aging) field and telesales management, broker/agent sales yield and increasing member retention rates for the CHA Medicare book of business. This includes accountability for sales performance management, process improvement and new producer recruitment. Business development responsibilities include indentifying and implementing strategic partnerships with new groups including corporate, retiree and non-profit associations. The position is also responsible for acting as the Team Leader for all sales producers working in concert with CHA operations, communications, training, reporting and broker development services.

The Medicare Sales Team Leader must have initiative and be resourceful in completing multiple projects. Strong leadership, interpersonal, project management, decision-making, and communication skills are required. The ability to collaborate across the organization with product, network management, communication and marketing, legal and/or finance is key in accomplishing the work of CHA sales manager - broker/producer development. This position's focus includes advising and assisting department leadership in the development and implementation of process and systems improvements with the goal of optimizing all distribution channels.

The Medicare Sales Team Leader will routinely work with all levels of CHA staff, MBS Finance, and IT within Medica as well as external parties including UHG/Ovations, CMS, and other vendors.

Bachelor's degree in healthcare, sales, business, or marketing required. Advanced degree preferred. 3+ years in Medicare healthcare marketing, sales and broker support. broker field experience a plus. Sales management experience preferred. Broker license a plus - work in progress acceptable. A successful candidate will have a practical knowledge and experience with telesales and broker organizations; Medicare products during the AEP, OEP and SEP enrollment period.

Medica offers a great work environment, an attractive salary and benefits package, employee wellness and training programs, on-site cafeteria, free fitness center, and miles of walking trails.

To apply to this position, please go to www.medica.com and Click on Careers tab. Select job requisition #9005 and complete online application.

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The North Shore-LIJ Health System is comprised of 15 hospitals (including three world-class tertiary hospitals as well as a nationally recognized children's hospital and a psychiatric facility), hospice and home care services, a major medical research institute and many other health-related facilities. As the largest employer on Long Island and one of the largest healthcare systems in the United States, the North Shore-LIJ Health System is "Setting New Standards in Healthcare" every day.

As one of the System's Corporate Compliance Directors you will be assigned responsibility for a number of our facilities to oversee and promote the Compliance Program. You will be responsible for the design and implementation of Compliance initiatives within your assigned facilities and System-wide, including but not limited to training and education programs, complaint investigations, and leadership of local compliance committees.

Other key responsibilities for your assigned facilities include:

• serving as the local Privacy Officer;
  
• assisting with the coordination of any internal and/or external compliance audits;
  
• conducting periodic compliance self-assessments
  
• participating on various facility committees to assist with quality and related initiatives
  
• drafting, implementing and communicating new and revised compliance policies
  
• advising facility employees, contractors and others, as appropriate, on issues of regulatory compliance

Qualifications:

• Bachelor's Degree in Business Administration, Hospital Administration or other related/appropriate field. A Masters Degree, J.D., R.N. and/or healthcare related certification(s) preferred
  
• Minimum seven (7) years related healthcare experience
  
• Current knowledge of compliance trends, issues and regulations
  
• Ability to write and speak clearly
  
• Previous experience delivering training programs, preferred

Candidates should submit a cover letter and resume via e-mail to KGreene@nshs.edu or via regular mail to Ms. Kim E. Greene, Deputy Chief Corporate Compliance Officer, North Shore-LIJ Health System, 200 Community Drive, Great Neck, NY 11021.

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The Pharmacy Manager will be tasked with all Pharmacy related duties in the continual support of Catalyst Rx's client Sandia.

ESSENTIAL FUNCTIONS:

• Provide concurrent drug utilization reviews to counsel patient medication therapies and monitor for drug-drug and drug-disease interactions and adverse effects.
  
• Provide medication counseling and education of durable medical devices specific to diabetic patient population
  
• Manage services at the Pharmacy operations level for improved patient communications and education.
  
• Manage and maintain consistent inventory levels reflective of Plan approved formulary
  
• Provide and administer vaccinations to patients
  
• Manage optimal pharmacist and pharmacy technician staffing and scheduling to deliver quality fulfillment services.
  
• Maintaining compound and dispensed prescriptions in a manner that complies with all legal requirements, including OBRA'90.
  
• Transferring prescriptions as necessary.
  
• Handling inbound/outbound physician calls to validate and fulfill prescription information.
  
• Provide accurate and consistent service levels focusing on timely and accurate medication distribution.
• Coordinate with other departments and team members within Catalyst Rx to provide maximum level of service.
  
• Ensuring adherence and compliance with all state and federal regulations pertaining to the Pharmacy.
  
• Manages staff pharmacist, pharmacy technicians, and any other staff related to the pharmacy
  
• Oversees Pharmacy Student/Externship Program
  
• Exhibits compliant and ethical behavior in the performance of job responsibilities, including complying with all applicable federal and state laws and regulations, HealthExtras Code of Conduct, Business Ethics Policies and Procedures and other policies and procedures applicable to position
  
• Actively participates in HealthExtras Compliance and Ethics Program, including attending annual compliance and ethics training and reporting suspected violations of the law or HealthExtras policies and procedures via HealthExtras Procedures for Reporting Incidents of Possible Improper Employment Practices, Misconduct, or improper Financial/Accounting Practices
  
• Performing other duties, as necessary, to meet the objectives of Catalyst Rx

QUALIFICATIONS:

• Current New Mexico Pharmacy License
  
• Doctorate of Pharmacy (PharmD)
  
• 2-5 years of Retail Pharmacy Experience
  
• Excellent interpersonal and customer service communication skills
  
• Supervisory experience
  
• Able to work a flexible schedule
  

Contact:
Lisa Calla-Russ
Senior Recruiter
Catalyst Rx
240 268 3184
lcallaruss@catalystrx.com

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The Financial Analysis Specialist is responsible for analysis and interpretation of financial information. Utilizing independent judgment and discretion, identifies trends, variances, and key issues and provides recommendations for adjustment. Responsible for conducting moderate to complex financial analysis projects and/or reporting. Prepares financial reports and recommends improvements in financial reporting systems. May conduct audits to ensure financial controls are maintained. May design, enhance and maintain system applications for processing and reporting financial information. May administer risk management and loss prevention programs to maintain maximum protection of the organization's assets at the most economical rates. May review and analyze insurance and risk management programs for effectiveness of coverage and to reduce insurance costs and losses. Requires a Bachelor¿s degree in finance or a related field and three to five years of financial analysis or related experience. May need knowledge of multiple systems. General knowledge of insurance products, procedures and systems for specific functional area. May support multiple products and/or accounts. Works with matrix partners.

Major Duties

Controller for CGI Marketing, Premium Admin, Divisional and Service Fees

Minimum Requirement: Bachelor degree plus 2-4 years experience.

• Develop timely department annual expense budgets and monthly re-forecasts for the CGI Marketing, Premium Admin, Divisional and Service Fees
  
• Oversee consolidation of CGI Plan as well as monthly expense analysis
  
• Provide accurate and timely monthly incurred expense variance and full year expense projection reporting to the departments and divisional expense controller. Identify risks, opportunities, and variances to Plan.
  
• Develop, deliver, and maintain routine financial and operational metrics reports to key departmental leadership and senior management.
  
• Monitor new hiring, and how it relates to Plan CGI headcount
  
• Provide financial & strategic consultation on proposed organizational change, project initiatives, resource allocation, & daily business decisions
  
• Perform expense-focused cost / benefit analyses on an adhoc basis
  
• Act as primary Finance department contact for Marketing, Premium Admin, Divisional and Service Fees. Provide operations with any and all financial support needed.
• Conduct periodic one-on-one meetings with key business partners to discuss and evaluate departmental/divisional expense issues. Provide proactive guidance for expense planning, projections, and reporting where appropriate.
  
• Ensure CGI expense tools and processes are fully utilized
  
• Support the development of an activity-based costing methodology as needed
  
• Participate in monthly and/or quarterly Management Operational Reviews, as appropriate, (specifically Marketing, Premium Admin, Divisional and Service Fees) and document key follow-ups and financial risks
• Lead New York legal entity expense planning, true-up, and analysis efforts for the division
  
  Pay Benefits Work Schedule
  
  CIGNA offers a competitive compensation and comprehensive benefits package including health and wellness benefits, 401k plan, and work/life balance programs, as well as opportunities for career growth and development.
  
  How To Apply
  

Visit http://careers.cigna.com/ and use ad ID 59088

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We are assisting a prominent Blue Cross Plan find their next top pharmacy executive . Reporting to a key senior healthcare delivery leader, this position is responsible for all facets of day-to-day pharmacy programs and operations. Specific responsibilities include: managing trend & spend, negotiating contracts, vendor management, compliance and UM. The best candidates will have a minimum of seven years pharmacy leadership in a health plan, PBM or health insurance carrier, thorough knowledge of and a proven track record of success in all areas of managed care pharmacy management, including managing staff. A PharmD and/or PBM experience a plus; great communications skills, creativity as exhibited with pharmacy strategy development is required. Great opportunity for a top pharmacy professional to bring new ideas and energy to an excellent plan in this role. Top salary, bonus, executive benefits and corporate relocation program. East coast location. Let me know if you would like to see a full job description or talk in detail about the position. You can always review our website for details on some of the other projects we are working on nationally.

Kevin Mandel
VP, Healthcare + Life Sciences Division
Solomon-Page Group, LLC
kmandel@spges.com

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The incumbent is accountable for assisting with reporting and analyses on initiatives that focus on the quality, economic and financial aspects of the Government and Commercial healthcare markets.

• You will assist with analysis, background research and reports for Quality Improvement, Management and Research Initiatives, EPSDT/TENNderCARE, HEDIS
  
• Data extraction and data preparation using SAS to execute deliverables for above mentioned functions
  
• Provide report development, analysis, design and execution of applied research activities to assist quality and medical management
• Present research findings internally and externally to appropriate professional forums
  
• Serve on related committees and workgroups
  

Qualifications:

• BS degree in Statistics, Biostatistics, Math, Public Health, Economics or other natural science discipline and 1-3 years of managed health care experience. An advanced degree in Statistics, Biostatistics, Math, Public Health, Economics or other natural science discipline may substitute for the work experience.
  
• Basic knowledge of statistics and experience using SAS, including data extraction, data preparation and working with large databases is required
  
• Survey experience a must
  
• Must have expertise with MS Office products
  
• Prior exposure to clinical concepts and coding
  
• Familiarity with regulatory guidelines and requirements (NCQA, HEDIS, CHAPS, CMS, EQRO, URAC, etc.) is desirable
  
• Excellent communication and presentation skills, both written and verbal are essential
  
• You must have experience in managing multiple assignments and must be able to demonstrate problem solving ability
• Please apply via our career site at:

https://www.bcbst.com/about/careers/openings/

Closes May 23, 2009

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Join an incredible team! Make an incredible difference! Work in an environment driven by inspiration and high expectations!

If you believe that you have what it takes to contribute to a quality company that earns its reputation every day, and you want to be recognized and rewarded for your efforts and skills, do not let this opportunity pass you by!

We are currently recruiting for a full-time HIM Manager in the West Los Angeles area, for a nationwide leader in the healthcare industry.

The successful candidate will plan and direct medical records information services in a consumer-oriented manner, ensuring that the needs and expectations of the Health System, medical staff, and others are met.

Leading a team of HIM professionals, this individual will also be instrumental in the development and deployment of our electronic Health Information Management system as we embark on the implementation of a comprehensive, state-of-the-art electronic medical records system.

Furthermore, this key member of our leadership team will play an integral role in the setting of the healthcare system’s standards for data quality and ethical practice.

To qualify, you must possess a Bachelor's degree in Health Information Management, Health Business Administration or a related field, with 3+ years of progressive medical records department management experience.

RHIA/RHIT certification is required. In this highly important role, knowledge of information systems and an understanding of how globally integrated health information systems are evolving is essential. The incumbent must possess strong goal orientation with a strong commitment to quality and ethical behavior. Strong analytical, planning, research skills and leadership skills are required. The ability to work within a 'team'
approach is essential.

We are looking for exceptional people who are interested in this incredible career opportunity!

For confidential and immediate consideration please forward your Resume and Cover Letter via email to Valerie at garzava@kellyservices.com

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We are seeking outstanding candidates that want to work with our clients implementing our healthcare information products. Client Account Managers manage all activities and oversee all aspects of implementation including identifying standards/benchmarks, data sources and resources needed to ensure a smooth implementation.

Our ideal candidate is a take charge/action oriented leader able to multi-task in a dynamic environment. The position also requires:

• 4+ years experience in HEDIS and/or Payment Integrity/Revenue Cycle/Medicare Risk Adjustment
• Knowledge of healthcare informatics, data analysis and outcomes measurement
• Experience with CMS or a Medicare MCO, Medical record vendor, HEDIS audit organization or NCQA
• Demonstrated project/process management success
• Proficiency in Microsoft suite of products
• Strong oral and written communication skills

Please contact Robbie Brock at (678) 534-3158 or rbrock@onsite-rs.com

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Physicians United Plan, a Medicare Advantage plan, is seeking Senior Provider Contractor and Network Development Professionals for offices in Orlando, Tampa and South Florida.
The candidate will have worked in provider relations or contracting in the managed care arena for a minimum of five years and is looking for increased responsibility and impact. Knowledge with hospital, MSO, large physician group and ancillary contracts including capitation and risk-sharing arrangements is essential. You will be working in a fast paced, small team environment where your performance will be recognized and rewarded.

E-mail cover letter, resume, and salary requirements to
HR@pupcorp.com.

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Physicians United Plan, a Medicare Advantage plan, is seeking Provider Contracting Specialist and Network Development Professionals for offices in Orlando, Tampa and South Florida. The successful candidate will have worked in provider contracting and network development in the managed care arena for a minimum of three years and is looking for increased responsibility and impact. Demonstrated experience with hospital, MSO, large physician group and ancillary contracts including capitation and risk-sharing arrangements is essential.

E-mail cover letter, resume, and salary requirements to
HR@pupcorp.com.

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Physicians United Plan, a Medicare Advantage plan, is seeking a Provider Relations Representative and Network Development for offices located in Orlando, Tampa and South Florida. The candidate will have worked in provider relations, serving in the managed care arena for a minimum of three years, and is looking for increased responsibility and impact.

E-mail cover letter, resume, and salary requirements to
HR@pupcorp.com.

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• Customer Integration working to develop and grow strong partnerships with key Managed Care Organizations within their Region. This includes ensuring the development of horizontal and vertical relationships with customers through their Account Managers and themselves. A significant facet of their position is to work with their team on securing profitable formulary access for the Schering-Plough product line at their key customers.
  
• Field Sales Integration is another critical component of their role. The SP USMM RD needs to work collaboratively with Senior Sales Management including, but not limited, to the National Vice Presidents of Primary Care Sales and their Regional Sales Directors. He/she should help set strategic business direction for their region. It is imperative that SP Product Formulary access (or in certain cases lack thereof) is turned into Product Market Share. He/she needs to work closely with Sr. Sales Management to drive the strategies to turn access into share. The USMM Regional Director also needs to drive in conjunction with their Account Managers, a strong cross-functional local team including field sales, CMMs, NAMs HSAMs, GAMs, MSLs and Merck/Schering-Plough personnel where applicable.
  
• The last major component of their role is Talent Development involving coaching, mentoring and motivating the Account Management Team that reports to them. In addition, he/she needs to be a Strategic Leader and role model for the entire SP USMM Team. The SP USMM Regional Director needs to be a cross-functional, communicative leader who focuses on building and driving SP business in their Region and across the entirety of the US marketplace.
  

Qualifications:

• BA/BS degree required; MBA or other advanced degree preferred.
  
• Successful work experience with 7-10 years of pharmaceutical sales, marketing, field-based and home office assignments.
  
• Comprehensive knowledge of account organization and business issues. Demonstrated strong leadership abilities.
  
• Strong written and verbal communication skills. Broad experience in many areas of pharmaceutical marketing, sales and managed care.
  
• Ability to manage multiple projects. Strong understanding of the Managed Care customers.
  
• Excellent interpersonal skills and knowledge of financial and account management principles. Proficient in all MS Office applications (Word, Excel, PowerPoint, Access).
  
• IT skills and application understanding a plus.
  

  Benefits:
  1) Medical Plan
  2) Dental Plan
  3) Vision Plan
  4) Prescription Drug Benefits
  5) Spending Accounts
  6) Employee Health Services
  7) Disease Management Program
  8) Short-Term Disability Program
  9) Long-Term Disability Insurance
  10) Basic Life Insurance
  11) Business Travel Accident Insurance
  12) Group Variable Universal Life Insurance
  13) Voluntary Accidental Death & Dismemberment Insurance
  14) Long-Term Care Insurance.
  

• Other Benefit Programs:
  1) Employee Assistance Program Group Legal
  2) Group Auto & Homeowners Insurance
  3) NJ Manufacturers Insurance Co.
  4) Schering-Plough Foundation Scholarship Program
  5) The 401(k) Savings Plan and the Retirement Plan
  6) Personal Financial Planning Program.
  Schering-Plough is an equal opportunity employer. M/F/D/V

Apply Here Now

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Position Overview

The Vice President of Business Development will report to the President/CEO and reside in the Corporate office located in St. Paul, Minnesota. Consistent with The Burchfield Group’s mission of providing new opportunities to improve pharmacy benefit programs while reducing client costs, the Vice President of Business Development will lead the sales and marketing initiatives to find new ways to increase new business and relationships to tailor solutions for the prospective markets.

Responsibilities

• Building on the Burchfield Group’s Brand, create the value proposition message that will lead the sales strategy
  As a key member of the Executive team, defines the sales strategy by identifying market segments (large employers, TPAs, special interest groups, Brokers, etc.)
  
• Direct sales activities within defined market segments
  
• Manage sales staff and work together to increase sales and deepen relationships within the assigned areas
  
• Develop and manage sales plans and budgets for assigned areas
  
• Establish and manage marketing and sales support initiatives to support and maximize sales efforts. May assist in the development and launch of new products and services
  
• Recruit and staff top sales and sales support talent
  
• Lead special projects contributing directly to sales efforts (i.e. – performance management, compensation, etc.)
  Establish and manage sales training initiatives
  Manage outsource partners and channel relationships
  

Qualifications Needed

• Bachelor’s degree, MBA preferred
  
• PBM knowledge and expertise
  
• 8+ years of sales and/or sales/marketing experience
  
• 4+ years of sales management experience and use of structured selling processes
  
• Significant experience with solution based selling to large employers and health plans
  
• Strong problem solving skills
  
• Proven ability to work in a progressive, fast-paced environment meeting deadlines with a positive attitude and cool demeanor
  
• Proven ability to develop and maintain effective, collaborative working relationships
  
• Excellent written, verbal, and interpersonal skills
  
• Experience with CRM and Microsoft based tools
  
• Willingness and ability to travel up to 50%
  

Contact Mary Nutting at mnutting@maintalent.com.

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Mount Sinai Medical Center is seeking a high energy, team-oriented individual interested in being a key contributor to the Finance Division. Reporting to the Director of Government Operations Management/Compliance, this position is required to understand and apply knowledge of third party reimbursement regulations including Medicare, Medicaid and all other major third party payors for the Institute. The position is also responsible for all aspects of regulatory cost reporting such as wage index review and audits.

Education and/or Experience Requirements: Bachelor's Degree or equivalent in Accounting, Finance or related field, with a Master's Degree in Business Administration or related area preferred. In addition, a minimum of 5-7 years related work experience in the healthcare industry with a minimum of 1-2 of those years in a supervisory capacity is required.

Extensive experience with Medicare cost reporting including the ability to perform strategic analyses is essential. Candidates must be able to function independently in a fast-paced environment while managing multiple priorities and have superior interpersonal and communication skills to effectively work and communicate with all levels of internal and external staff. This position requires superior computer skills, i.e., MS Access, Excel, Word, and PowerPoint. Experience with Starr Patient Accounting, Lawson General Ledger and SQL reporting is a plus.

Function:

• Be able to demonstrate a thorough knowledge and understanding of Medicare Reimbursement laws.
• Be able to ensure complete, accurate and timely filing of Medicare Cost Report and other program related documents.
• Demonstrate the ability to coordinate efforts to maximize Governmental reimbursement.
  
• Be able to coordinate and supervise all Government reporting audits.
• Demonstrate the ability to continually inform and in-service internal and external staff as to Medicare/Medicaid regulations/policies.
• Be able to identify interdepartmental process flow problems, makes suggestions for positive changes in the department and develops action plans to implement these improvements

Candidates should forward resumes to: mcopelan@MSMS.com

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A Bachelors Degree is required, an MBA preferred. We seek individuals with: 15+ years of continuously increasing responsibility in marketing management, including 3 - 5 years in product marketing or brand management. An exceptional track record of developing and implementing creative marketing strategies that have consistently met or exceeded planned objectives. Outstanding strategic planning and analysis skills in marketing and business strategy. A strong set of interpersonal skills, maturity, good judgment and be capable of communicating across a diverse range of individuals. Keen business acumen, and the ability to function as a senior strategist with key members of the executive management team. The ability to recruit and develop senior leaders and craft a empowered marketing organization. The ability to work collaboratively with colleagues and staff to create a results-driven, team oriented environment.

Compensation includes a very competitive base salary, annual performance bonus, long term incentive compensation plan, and a full benefits package (health/medical insurance, 401k, etc.) Candidates with appropriate qualifications and experience can anticipate total annual compensation in the second six-figure quartile.

For immediate consideration, qualified individuals are encouraged to promptly email their resume in complete confidence. Direct all inquiries to Ms. Leslie Rule at leslie@custergroup.com and please reference VPM1016 in your correspondence. Mail responses should be sent to Research Department, The Custer Group, 6005 Tattersall Court, Brentwood, TN 37027 (615) 465-8434. Email response is preferred and will receive priority.

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Quality Health Solutions, is seeking qualified candidates for health coaching positions.

The successful candidate will provide health coaching services by phone to wellness program participants. Common topics include weight loss, blood pressure management, cholesterol management, increasing physical activity, stress management and smoking cessation.

Health coaches will initiate the program with new participants, develop rapport, and follow-up with multiple coaching calls. They will document health coaching activity in an electronic database and manage a case load of participants.

Degree in health promotion, psychology, or other health-related field is preferred. Knowledge or work experience in health behavior change and strong communication skills required. Experience or training in Motivational Interviewing preferred.

The position is part-time and has flexible hours. The ability to work afternoons and evenings is preferred. Willingness to work one weekend day per month is a plus. Occasional travel to client sites may be involved.

Please send resumes to: info@qualityhealthsolutions.com or via mail to Quality Health Solutions, Human Resource Department, PO Box 174, Lake Oswego, OR 97034.

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The nation's largest health-care services network devoted exclusively to cancer treatment and research, and a pioneer in community-based cancer care since 1993. Today this network includes over 850 affiliated physicians who deliver care to more than half a million cancer patients each year.

Scope of the Job:

This new position, located at Corporate Headquarters in Texas, reports to the Vice President/General Manager of Medical Oncology. Your primary responsibility will be to direct and oversee all aspects of the Cancer Care Management business unit. This includes, but is not limited to strategic and operational planning, financial management and forecasting as well as business development. You should have the experience necessary to build a world class Cancer Care Management business.

Your responsibilities will include:

• The Management of the Cancer Care Management staff in order to drive the sales, marketing and product execution of payer solutions.
• Providing overall strategic vision and alignment of staff roles to achieve it.
• Creating and monitoring aligned incentive plans for practices and employees to maximize program performance and results.
• Developing and maintaining relationships with physicians to build business lines.
• Developing mid-range and long-term product development plans in anticipation of future needs.
• Identifying and pursuing opportunities for increased operational productivity and revenues with maximal cost efficiency.

Candidate Requirements:

• We seek a professional with 15 years of combined healthcare operations, sales and marketing experience.
  
• Candidates must have healthcare services experience and should have a track record of working with or within managed care organizations.
  
• For the best fit you should be a collaborative team player who is passionate, hands-on and a team builder.
  
• Candidates must have successfully demonstrated the ability to profitably build and scale up businesses.
  
• We seek a professional with a Master's Degree in Business Administration, Healthcare Administration or Public Health.
  

Compensation:

A compensation package will be designed to attract outstanding talent and will include a base salary and performance bonus.

Contact
Wolfetwolfe@zingaro.com
(512) 327-7275

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• Monitor post sales education regarding program analysis; implementation; and support related to the prevention of patient falls and development of healthcare acquired pressure ulcers. Adverse event prevention programs might be added or deleted based upon health care quality trends.
  
• Clinically assess health care organizations related to the effectiveness of current processes and protocols regarding the prevention of patient falls and pressure ulcers.
  " Collaboratively work with individual health care organizations to ensure successful implementation of key program and process elements resulting in customer satisfaction.
  
• Develop and present individual health care organization assessment findings
• Support in-servicing initiatives.
  
• Implement and monitor account specific clinical programs and protocols to enhance patient outcomes and decrease adverse events.
  
• Present clinical programs.
  
• Data collection and follow up on program success.
  
• Ability to prioritize projects.
  
• Thorough communication with health care organizational team; clinical excellence team; and supervisor.
  
• Other duties may be assigned.
  

EDUCATION AND/OR EXPERIENCE REQURED:

• RN, BSN required.
  
• Must have minimum of 3 years adult med surge/acute care experience.
  
• Experience/knowledge of quality and performance improvement processes, team activities, health care quality initiatives, and programs monitoring.
  
• Experience with standards implementation.
  
• Strong interpersonal and communication skills, analytical problem-solving skills, confident, and display leadership abilities.
  
• Ability to successfully implement clinical programs.
  
• Ability to present program education to implement best-practice and evidenced-based standards for high-level quality patient outcomes.
  
• Skill set to be viewed as a clinical resource in determining best-practices.
  
• Excellent presentation and report development skills.
  
• Computer literate (Microsoft Suite).
  
• Must be able to work in team environment or on own.
• Exceptional Communication Skills to successfully overcome resistance to change and drive program enhancements.

FOR IMMEDIATE CONSIDERATION, PLEASE APPLY ON-LINE:

https://v2.projectix.com/hill-rom/jobboard/NewCandidateExt.aspx?__JobID=1840

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Community First Health Plans, a locally-owned and operated not-for-profit HMO, was established in 1995, by University Health System, specifically to begin providing health care coverage to the citizens of Bexar and the surrounding seven counties. Our commitment to our members is to provide exceptional health care benefits backed by outstanding service, delivered by people who live right here in South Texas.
In our ten years of existence, we have made great strides in becoming a fully mature health plan with a strong balance between our commercial and government-sponsored programs. Our 110,000+ members are divided almost equally among Commercial, Medicaid and Children's Health Insurance Program (CHIP).

Position Summary
As the Supervisor of Health Services Resolution, the selected candidate will ensure that all member/provider oral or written UM complaints and appeals are acknowledged, investigated and resolved according to CFHP policies, as well as those of the National Committee on Quality Assurance (NCQA) and federal & state regulatory entities. It will be the supervisor's responsibility to enhance Community First's reputation for prompt, fair handling of complaints and appeals. Supervises the activities performed by Community First staff regarding the UM complaint process and all aspects of the UM appeals process, including documentation, coordination with Community First departments, and organization of the Complaint Appeals Panel and other required elements of the process. Additionally, he/she will continuously ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies in regards to all aspects of operations within Health Services.

Qualifications Required
Graduation from an accredited school of professional nursing is required, BSN preferred. A current license to practice professional nursing or to practice vocational nursing issued by the Texas Board of Nurse Examiners is required. Minimum of two years experience in managed care and/or the insurance industry is required, preferably in a management capacity. Five to ten years of progressively responsible experience along with an associate's degree in nursing or a licensed vocational nurse may be substituted in place of a bachelor's degree. A minimum of one year experience in managed care complaints and appeals resolution or quality improvement/management is preferred. Must demonstrate a complete or thorough knowledge of medical review criteria used to make utilization review decisions

How to apply:
Please complete an online application at www.UniversityHealthSystem.com/hr for immediate consideration. You may also submit your CV to 210.358.4765 or rosa.ramirez@uhs-sa.com. University Health System is an equal opportunity/affirmative action employer.

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Albert Einstein Medical Center, with more than 700 beds, is a teaching hospital offering a full range of advanced health services to patients of all ages in the Philadelphia Community. Our specialties include routine to highly specialized medical and surgical treatment. Some factors that contribute to our top rankings are specialized intensive care units, state-of-the-art inpatient and outpatient operating suites, a Level-1 trauma center, the latest diagnostic technology, and a high level of commitment from our dedicated and experienced staff of physicians and nurses.

In this role, you will assume immediate responsibility for:

• Assisting in the implementation, coordination, assessment, evaluation and development of Albert Einstein Healthcare Network's Quality Management and Performance Improvement Program for the Heart Institute
  

If you possess the following experience, please apply immediately:

• Bachelor of Science in Nursing preferred
• Minimum of one to two years Cardiac Nursing experience required
• Minimum of one to two years experience in Quality Management/Performance Improvement required.
• Strong knowledge of medical terminology required
• Strong computer skills including knowledge of Microsoft Office required
• Ability to perform basic analysis of information is required
• Strong organizational skills required
• Ability to work independently required
• Licensed as a professional Nurse in Pennsylvania

Albert Einstein Healthcare Network offers its employees unparalleled career opportunities including competitive compensation, attractive benefits plan including medical/dental/vision coverage with health insurance coverage effective the first of the month after hire. We also offer generous vacation time, tuition reimbursement and low-cost employee parking. EOE.

Please apply online using the following link to the Albert Einstein Healthcare Network website:

https://v2.projectix.com/einstein/jobboard/
JobDetails.aspx?__ID=*A017F034683F68BC

To learn more about all AEHN job opportunities please visit our website at www.einstein.edu , go to career opportunities, and browse all jobs!

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