Health Business
Job Openings

To list your job openings for FREE, e-mail them to B.J. Taylor, with "job listing" in the subject line. Job listings are in chronological order with the most recent posted first. Openings listed below were confirmed on Aug. 3, 2010, to make sure they are still available. To see the preferred job posting format, click here.

• Lexington Medical Center, Managed Care System Analyst

• Lexington Medical Center, Patient Access Manager

• Harvard Pilgrim Healthcare, Chief Medical Officer

• Blue Shield of California, Health Data Reporting Director

• Blue Shield of California, Director of Small Group Sales

• Confidential Medical Cost Management Company, VP, Medical Director- Product Development and Marketing

• Confidential Physician Practice Management Company, VP, Practice Development

• Confidential Healthcare Services Company, VP, Information Technology

• Sterling Life Insurance Co., Case Manager

• Prescription Mail-order Facility, Specialty Pharmacist Manager

• EMD Serono, Inc., Director Account Management Strategy & Regional Business
• Confidential Healthcare Company, Healthcare Project Managers/Business Side Projects (Consulting Assignments)

• Confidential Health Insurance Company, Director of Advertising and Branding

• The Independent Drug Information Service, Program Director

• Health Plan, Vice President of Managed Care

• Windsor Health Group, Inc., Actuary

• CatalystRx, Client Services Director

• CatalystRx, Clinical Consultant

• Mercy Physician Group, Chief Financial Officer/Finance Director

• Windsor Health Group, Inc., Medicare Compliance Auditor

• Windsor Health Group, Inc., Compliance Specialist

• Pfizer Inc., Senior Manager (P5), Enterprise Infrastructure Architect

• The Burchfield Group, Sales Vice President (Large Employer Market)

• UCare, Federal Government Relations Manager

• Confidential, Data Analytics Consultant

• Vermillion Group, VP Care Management
• Vermillion Group, Regional CMO
• DST Systems/Argus Health Systems, CMS Regulatory Compliance Manager
• Health Plan, Vice President of Operations
• Health Plan, Vice President Compliance

• Health Plan, Vice President of Medical Management

• Healthfirst, Healthcare Analyst

• AIDS Healthcare Foundation, Compliance Officer

• Gorman Health Group, Senior Consultant

• CardiaCall, LLC, Cardiac Event Monitoring Sales Representative

• Confidential, Program Manager

• Confidential Health Care Product, Services Company, President

Lexington Medical Center

Managed Care System Analyst
West Columbia, S.C.

Job Details:

Basic Functions:

Administers all functions related to the Managed Care Departments contract management system (Physician Pro) and provides reports and analytical support related to managed care reimbursement. Position researches identified "short pays/underpayments" by contracted payers and aggressively pursues recovery of funds. Identifies patterns or recurring trends with payers that consistently do not reimburse in accordance with contracts and communicates this information to the appropriate parties (supervisor, payer representatives, etc.)

Minimum Qualifications:

Bachelors degree, business related, plus three years experience in healthcare/finance/managed care environment OR High School Diploma, plus 8 years of healthcare experience in finance or manage care environment

Experience with mainframe, PC, and network computer systems. 

Knowledge of computer hardware for installation and upgrades, relational database systems, and file and system maintenance procedures.

Must have knowledge in Managed Care operations as it relates to claims processing and reimbursement.

Preferred Qualifications:

Working knowledge of Patient Financial Services.

Working knowledge of managed care terminology

Procedural knowledge of hospital and physician practice accounts receivable management

Working knowledge of billing/coding terminology (ICD-9, CPT, Revenue Codes)

 To apply, visit http://www.lexmed.com/careers/

(Posted 8/30/10)

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Lexington Medical Center

Patient Access Manager
West Columbia, S.C.

Basic Functions:

Manages the daily operations of Patient Access including the following departments:  Emergency Room Registration, Central Registration, Radiology, Women’s Imaging, Bed Control, Insurance Specialists and Registrars in Physician Practices.

Minimum Qualifications: 

• Bachelor’s degree
• 5-7 years of management experience in full range of patient revenue cycle
• Procedural knowledge of Medicare, Medicaid, third party billing, reimbursement, corporate compliance and regulatory compliance.
• Familiar with medical terminology, insurance billing, coding, data capture/registration systems, eligibility access systems, imaging systems, managed care requirements and medical record documentation requirements.
• Experience managing multiple sites with skills in providing a bridge between Patient Access and clinical activities to improve financial/clinical outcomes.
• Demonstrated ability to lead and manage employees including selecting, developing, motivating and retaining staff to meet the department’s objectives.

To apply, visit http://www.lexmed.com/careers/

(Posted 8/30/10)

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Harvard Pilgrim Healthcare

Chief Medical Officer

Burlington, Mass.

Witt/Kieffer, on behalf of Harvard Pilgrim Healthcare, is seeking an outstanding executive for the position of Chief Medical Officer.

Harvard Pilgrim Health Care (HPHC) is a full-service health benefits company serving members throughout Massachusetts, New Hampshire and Maine. An independent, regional, not-for-profit health plan, HPHC, provides a variety of healthcare benefit options for companies, families and individuals.  With a membership of more than one million members, their mission is to improve the health of the people the organization serves and the health of society.  HPHC is financially strong with operating income of $10.1 million on revenues of $2.7 billion. Net income for 2009 was $20.8 million.  U.S. News & World Report/ NCQA named Harvard Pilgrim as the #1 commercial health care plan in America in 2009. HPHC topped the list of America's Best Health Plans for a fifth consecutive year. J.D. Power and Associates named it as the highest-ranked health plan in New England. 

The Chief Medical Officer will report directly to the Chief Operating Officer of Harvard Pilgrim Health Care. This person will be an integral member of the senior management team and participate on the Enterprise Leadership Council.  The CMO will be expected to assist in providing and supporting the strategic vision for the organization, as well as being the external face of HPHC in the medical community. The CMO manages all aspects of performance (cost and quality) related to clinical services obtained by and offered to Harvard Pilgrim members. This includes clinical oversight of HPHC’s provider network and credentialing standards, pharmacy and behavioral health, medical management programs, and corporate NCQA compliance. The CMO oversees the medical cost control agenda and partners with the Senior Executive for Provider Network to manage HPHC’s relationships with approximately 130 hospitals and approximately 20,000 providers in Massachusetts, New Hampshire, Maine and Rhode Island. The CMO is the Vice-Chair of the Harvard Pilgrim Health Care Institute’s Board of Managers, and represents HPHC in a variety of regional and national forums.

This is an extraordinary opportunity for a physician executive to do the best work of their career and make his or her mark in one of the highest quality health plan markets in the country.  We seek a physician executive with a minimum of five years of clinical practice.  Candidates will have a minimum of 10-15 years of demonstrated medical management experience. Current or past experience as a Medical Director or Chief Medical Officer in a managed care organization is preferred; Medical Directors or CMOs from other complex health care organizations will be considered.  Proven track record of managing multiple projects and leading a large staff in an environment that is undergoing substantial change is desired.

For additional information regarding this opportunity, please email HarvardPilgrimCMO@wittkieffer.com or contact Steve Kratz by phone at (404) 233-1370 or by mail at c/o Witt/Kieffer, 3414 Peachtree Road, Suite 352, Atlanta, GA 30326 or Tom Quinn by phone at (781) 272-8899 or by mail at Witt/Kieffer, 25 Burlington Mall Road, 6^th Floor, Burlington, MA 01803.

(Posted 8/26/10)

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Blue Shield of California
Health Data Reporting Director
San Francisco

Blue Shield of California is looking for a  Health Data Reporting Director will provide oversight and management of health data reporting and analysis function to develop accurate and insightful group health performance for Large Group Specialty Benefits (LGSB) and CalPers, Labor, Public and Strategic Business Unit (CPLPS) businesses. The Health Data Reporting Director will report to the VP, Large Group Finance and Underwriting. 

The Director will be responsible for the folllowing:

• Along with LGSB and CPLPS senior leadership, present group  health performance, analytics,
and insights to prospects and renewal groups, brokers and producers to land large size accounts

• Provide in-depth cost of healthcare (COHC) analytical supports to LGSB management team to ensure accurate pricing for LGSB employer group business.

• Provide education and consultative services to large size accounts. This service is a key differentiator for
groups employing Blue Shield of California (BSC)  as their health carriers

Develop the COHC education and consultative services as a revenue stream for mid/large employer groups

Critical responsibilities for this role will include:

Interface directly with senior executives of our large sized accounts to provide education, insights, and consultative services including explaining group health performance, dissecting COHC trends and resulting financial implication to the account, projecting the group specific COHC trend and brainstorming actionable solutions to manage cost of healthcare drivers

Partner with CPLPS leadership team in final sales presentation for large sized accounts and strategize with the senior CPLPS and LGSB executives on how to land and/or renew the account

Act as a key strategic thought partner for mid/large business to drive accurate pricing, manage risk selection, and partner with mid/large GMs on how to develop stickiness of brokers and clients through understanding the COHC dynamics by group and claim experience

Oversee and manage a team of 12 health reporting specialists/managers and work with other key company stakeholders to develop fully insured and self funded customer reports and cohc data analytics tools for CPLPS and LGSB clients/brokers/producers and provide ad hoc analytics to prioritized clients.

The organization will evolve into a profit center for mid/large because of the healthcare intelligence built behind these reports and the consultative services priced in the healthcare insurance package

Partner with LGSB and CPLPS leadership to grow self-funded business through building stop loss internal and external reporting capability.

Candidate Profile and Requirements:

• Ability to understand complex COHC drivers and articulate into a simple manner for non-healthcare
sophisticated clients, brokers, and producers to understand and be able to influence these stakeholders to engage BSC as their carrier

• Accurately assess the COHC issues on the fly and position the COHC trend to BSC pricing advantage
 with senior executives of client groups, brokers and producers

• Ability to demonstrate the value of HDR, solve complex COHC problem, present and negotiate
with client group on pricing in final presentation

• Accurately assess risk of member groups along with leaders in the underwriting department in order to effectively price and compete with an intensely price sensitive market – this requires someone who possesses good business judgment and deep COHC knowledge

• Leverage business acumen and in-depth COHC knowledge to perform appropriate COHC analyses to
support complex business decisions

• Constantly make judgment on resource prioritization and allocation within his/her team to support
different business priorities within and across 2 business units

• Think outside of the box when helping to set strategic directions for a growing business, like self-funded or selling a new large sized group

• Require to think about second and third order implications of each direction set by him/her and chained effects on different parts of the organization

• Set directions and guide execution for 12 person team

• Act as a centralized hub for in-depth and single source of truth for COHC knowledge among finance, underwriting and sales which requires reasonable understanding of each role/function and know how to integrate the three diverse areas on a common platform

• Develop analyses to support and recommend policy making and changes.

Education/Credentials:

The successful candidate will have a bachelor’s degree and preferably a graduate degree. The Director will be a conceptual thinker, strong
healthcare industry background, management experience, health data reporting and analysis, SAS, Business Objects, Analysis and Solutions for Health Care Cost Drivers.

A minimun of 12 years of managing complex structure with matrix relationship, performing and managing healthcare cost and in a management experience is needed.

Interested executives should submit a resume to:
Wanda Cole-Frieman
Executive Recruiter, Talent Acquisition & Diversity
50 Beale Street, 22nd floor
San Francisco, California 94105
D: 415-229-5303
E: Wanda.cole-frieman@blueshieldca.com

(Posted 8/26/10)

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The Director of Small Group Sales, ISGBU, is responsible for providing the overall strategic sales direction and sales leadership for the Small Group sales line of business statewide for Blue Shield of California. This person is responsible and accountable for new sales volume and growth of profitable Small Group business.

A key focus will be demonstrating  exceptional leadership capabilities

in:

people management  and leadership development, highly achievement and  results oriented, strategic and tactical planning, analytics as evidenced by the ability to model, forecast and plan, team building and communication, change management and results orientation.  The ability to effectively lead and represent BSC while maintaining and enhancing broker and general agent relationships is essential to succeed in this capacity.

QUALIFICATIONS:

The Director of Small Group Sales will be a well rounded and highly talented executive with extensive  experience developing strong team and cross-functional relationships with key stakeholders. A successful candidate will thrive in an achievement oriented, collaborative and team-driven environment and will make direct contributions towards achievement of our sales strategy. The successful candidate will have a bachelor's degree and preferably a graduate degree.

Interested executives should submit a resume to:

Wanda Cole-Frieman, Executive Recruiter, Talent Acquisition & Diversity

D: 415-229-5303

E: Wanda.cole-frieman@blueshieldca.com

(Posted 8/24/10)

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Confidential Medical Cost Management Company

VP, Medical Director- Product Development and Marketing

Southwest Location

Our client is a large, rapidly growing medical cost management company that is focused on increasing the quality delivery of clinical services as well as helping its client's provide the most cost effective solutions to their members and employees. The company is expanding its product offerings significantly and as part of that process they are in
need of a strong additional clinical resource in the form of a newly created Medical Director position. This job is different from a standard Medical Director role, in that it will be focused primarily on the product development function and will work with the SVP-Marketing and Product on new product offerings as well as manage the Product
Development staff.

The best candidate's will be a board certified MD with 5-10+ years health services, DM or health plan Medical Director background with substantial experience in the product development process from ideation to completion and roll-out. Strong clinical background, advanced business degrees, people management and subject matter expertise in health services and DM all preferred.

Excellent compensation plan, executive benefits and relocation assistance. Position requires relocation to corporate headquarters, commuting or remote work is not an option.

For more confidential information contact: Marc Gouran, Solomon-Page Group at mgouran@spges.com

(Posted 8/20/10)

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Confidential Physician Practice Management Company

VP, Practice Development

New York Metropolitan Area

Our client is a large, growing, publicly traded specialty physician practice management company headquartered in the New York metropolitan area.  They are seeking a new Vice President of Practice development to work on a national basis overseeing all aspects of the business development and strategies to grow patient volume and efficiency/quality of services and to manage a small team.  Responsibility and accountability for the company’s largest division’s overall practice development strategy, leadership and financial results are primary.  The VP of Practice Development is responsible for the development, utilization and integration of the marketing and sales resources to build new patient volume and improve patient retention at their network of specialty practices.  This person will also have overall responsibility for establishing a clear set of performance objectives and executing an action plan to achieve those objectives at both a divisional and practice level.  Performance will be measured by conversion of patient leads produced by various marketing programs to new patient visits across the network, utilization of the company’s proprietary programs across the network and growth of new patient visits, overall volume and revenue at practices. 

The best candidate’s will have a MBA, MPH or other relevant advanced degrees; 10 years+ working in physician practice management, hospital business development and marketing, physician practice consulting or related healthcare marketing/business development work.  Excellent compensation, executive benefits and a high growth opportunity. 

No relocation assistance, local candidates from NY tri-state area. 

Contact with complete confidentiality: Kevin Mandel at the Solomon Page Healthcare Group at kmandel@spges.com

(Posted 8/17/10)

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Confidential Healthcare Services Company
VP, Information Technology
Lower Westchester County, N.Y.

Our client is a large publicly traded specialty national healthcare services company headquartered in lower Westchester county.  They are seeking a new Vice President of Information Technology to provide strategic vision and day-to-day leadership for the operations, security and compliance of the organization’s IT infrastructure.  This is a unique, equity-participating opportunity to make a major impact on an already successful, rapidly growing organization. 

Successful candidate will partner with internal senior stakeholders to drive development of IT strategies and applications to best support individual business lines; lead and develop IT staff; foster exceptional internal customer service IT production environment; manage Disaster Recovery and Business Continuity Planning; provide on-going IT thought leadership; provide planning, budgeting and appropriate analysis for identified potential IT needs; act as Chief Information Security Officer; manage applicable vendor relationships; negotiate contracts; manage on-going IT auditing effort; maintain effective internal IT controls; plus other duties as needed. 

The best candidates will have 10+ years of progressive experience and exceptional accomplishments as an IT leader in the healthcare sector, with provider-oriented experience preferred; entrepreneurial, and hands-on sensibility as well as big picture, strategic and thought leadership capabilities a must. Excellent compensation, executive benefits and a high growth opportunity. 

No relocation assistance, local candidates from NY tri-state area. 

Contact with complete confidentiality: Rachelle Andersen at the Solomon Page Healthcare Group at randersen@spges.com

(Posted 8/17/10)

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Sterling Life Insurance Co.
Case Manager
Atlanta

Summary: The Case Manager coordinates the care and services of selected member populations across the continuum of illness.  Promotes effective utilization and monitors health care resources.  Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes.  Works with the Supervisor / Manager of Utilization/Case Management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the Member.  Incorporates Disease Management process and principles into the process to promote member empowerment.   

Duties and Responsibilities:

• In conjunction with the PCP and member, completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the member's need for alternative services.  Assess short-term and long-term needs and establishes case management objectives.  Address the individual member/enrollee/client’s physical and psychosocial needs to ensure appropriate protocols and service delivery.  Address deviations between requested and approved plans with the practitioner.
• Interacts continuously with member, family, physician(s) and other providers utilizing clinical knowledge and expertise to determine medical history and current status.  Assess the options for care including use of benefits and community resources to update the care plan. Monitors, evaluates, extends, revises or closes treatment plans as appropriate
• Acts as liaison and member advocate between the member/family, physician and facilities/agencies. 
• Maintains accurate records of case management activities in the Medical Management System using evidence-based clinical guidelines.
• Coordinates community resources with emphasis on medical, behavioral and social services.  Applies case management standards and maintains HIPAA standards and confidentiality of protected health information. Reports critical incidents and information regarding quality of care issues.
• Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
• Participates in monthly chart audits and at least weekly case rounds.
• Identify cases with potential high-risk complications and act as an advocate for the individual’s health care needs.
• Responsible for developing and maintaining a comprehensive list of community resources to utilize in the case and disease management process.
• Negotiate preferential rates with selected providers, when appropriate.
• Maintain confidentiality, security and integrity of data and information.
• Maintain departmental quality and productivity established benchmarks and goals.
• Maintain enrollee/member/client/patient and provider satisfaction based on pre-established departmental goals and benchmarks.
• Work collaboratively with other case management team members and support staff.
• Participates on and performs special projects and other related duties as assigned.

Knowledge, Skills, and Abilities:

• Working knowledge of Medicare rules and regulations effecting health services to Medicare enrollees
• Working knowledge of ICD-9, CPT coding and claims processing
• Strong grasp of the nursing process and the ability to effectively utilize it in the coordination of care
• Excellent time management and prioritization skills
• Excellent oral and written communication
• Demonstrates negotiation skills
• Ability to create, review and interpret care plans including use of evidence-based guidelines
• Ability to perform research utilizing the web or other resources on medically related areas
• Demonstrate ability to assess, interpret and provide interventions based on age specific data
• Demonstrates knowledge for adult enrollees/members/clients/patients: skills to evaluate appropriate care; principles of growth and development over the life span; mandated reporting laws; ethnic, religious and cultural impact in the diagnoses and treatment of chronic illness.
• Able to demonstrate age competencies
• Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
• Valid state driver's license and access to a personal mode of transportation

Education and Experience:

• Unrestricted Registered Nurse license in applicable state or active license in a state allowing “multistate privilege to practice”. 
• Three years of clinical nursing experience, preferably with adult and geriatric population
• 2 or more years current case management experience in a health insurance or managed care environment
• Experience with utilization of evidence-based guidelines
• Working knowledge of Commission/URAC and NCQA case management standards, call center standards, triage principles, and standardized payor decision support tools (i.e., Milliman and Robertson and Interqual)
• Prior experience in utilization and/or case management in a health insurance/managed care company

Desired:

• Certified Case Manager designation (should be obtained within 30 months of employment)
• Two to three years of case management experience in a managed care environment
• Bilingual
• Previous case management experience within a Medicare/elderly population 

Essential Functions:

• Manual dexterity in hands to do extensive keyboarding
• Requires the ability to sit for extended periods of time
• Eyesight required for the ability to view print on a computer screen and/or paper document
• Requires the ability to speak and hear to exchange information with customers by telephone

To apply, visit www.sterlinglife.apply2jobs.com.

(Posted 8/17/10)

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Prescription Mail-order Facility

Specialty Pharmacist Manager

Northeast Ohio

POSITION DESCRIPTION

• Pharmacology knowledge that will enable the identification of drug interactions, potentially dangerous side effects, appropriate dosage requirements and dosage calculations which meet with medically recommended solutions.
• Develop and manage specialty pharmacy compliance, adherence and utilization programs
• Develop utilization review programs of patients’ drug therapy and make appropriate recommendations
• Assist in coordinating care among physicians, patients and payers

REQUIREMENTS

• Bachelors Degree or Pharm D in Pharmacy
• Current OH Pharmacist License required and must be in good standing with the State Board of Pharmacy
• At least two to five years of general pharmacy or pharmacy benefit management experience
• Specialty Pharmacy experience or knowledge is required
• May be required to be on call on a rotational basis
• Flexibility to work days/nights, weekends and select holidays as needed 

Interested candidates should email their resume and salary requirements to hr@rxoptions.net. We offer a competitive salary and excellent benefits. Pre-employment drug screening and background checks required.

(Posted 8/17/10)

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EMD Serono, Inc.
Director Account Management Strategy & Regional Business
Rockland, Mass  

Description

Reporting to the VP, Account Management, the Director, Account Management Strategy and Regional Business is responsible for overall development, coordination and execution of MM Account Management strategy, including external and internal customer operations-related activity.  Specifically, the role will drive Managed Markets and Account Management Excellence through their responsibilities for leading and planning:  Customer Development strategy, core Account Management and Account Team processes, POA and AM Team Meetings, AM Training, Customer-related activities including account analysis, Executive Exchanges, and contract negotiations; and by serving as a primary liaison between the AM team and other internal departments.

Qualifications

Minimum:10-12 Years Bio-Pharmaceutical/Health Care Industry experience with at least 5 years of Sales experience in the Managed Care environment including:

•  Sales Management experience, preferably within Managed Markets
• Account Management Experience at the National Account level
• Contract Management and Analysis experience
• POA and Meeting planning experience, preferably within Managed Markets
• Prior Sales Incentive Planning experience, preferably within Managed Markets
• Proven Project Management skills, supported by strong cross functional team leadership skills
• Proven Operational skills, supported by stong QPI and resource management skills
• Experience working within a highly matrixed organizational structure

• Managed Markets CRM/SFA development experience
• Managed Markets Training and Development experience
• Biotechnology/injectables and Specialty Pharmacy channel experience
• Outstanding oral, written and communication skills.

Please submit resumes via our website at http://www.emdserono.com The Company is an Equal Employment Opportunity Employer. No employee or applicant for employment will be discriminated against on the basis of race, color, religion, disability, military or veteran status, genetic information, or any other classification protected by applicable federal, state, and local law.

(Posted 8/16/10)

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Confidential Healthcare Company
Healthcare Project Managers/Business Side Projects (Consulting Assignments)
New York City

Our client is a large, not-for-profit multi-site, multi-product integrated New York City healthcare company that is seeking experienced healthcare Project Managers for a wide variety of new projects related to a major enterprise-wide re-organization and enhancement effort.  These projects will last from 2-6 months (with the opportunity for extension) and will be multi-functional, working on the business-side of the organization with the senior executive team. These are not IT-driven projects, but will touch operations, finance, sales and marketing, medical management, regulatory and compliance and other areas. 

The best candidates will be experienced managed care or delivery system generalists and/or consultants, with broad skills, heavy project management skills, great organizational skills, ability to work across broad parts of a large complex organization, high energy and brainpower. Top hourly compensation and the ability to potentially convert to full-time employment. 

Contact Rachelle Andersen, Solomon Page Healthcare Group at randersen@spges.com

(Posted 8/16/10)

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Confidential Health Insurance Company
Director of Advertising and Branding
Florida

Our client is a large, rapidly growing, multi-billion dollar health insurance company located in Florida.  We are seeking a Director of Advertising and Branding to oversee a number of key marketing functions for the company in a newly consolidated and enhanced role.  Responsibilities include: oversight of all advertising programs for the company using both traditional and new media resources and the management of a large budget; management of the corporate sponsorship programs; providing marketing support for the continued development of their consumer and retail marketing channel; helping to develop and deliver consistent branding and messaging across all business lines; managing a small staff and a substantial number of outsourced vendors and agencies and helping to set the overall marketing direction for the enterprise. 

The best candidates will have a top school marketing MBA, 10+ years experience in a top agency environment and/or in senior marketing roles for Fortune 500 companies, excellent creative skills and sensibility, vendor management, a high energy work ethic and excellent management and communication skills . Healthcare background is not required, but substantial experience in very progressive marketing environments is.  Relocation to Florida is required and is non-negotiable, top compensation, executive benefits and full corporate relocation is provided. 

To apply with complete confidentiality please contact:  Marc Gouran, Solomon Page Healthcare Group at mgouran@spges.com

(Posted 8/16/10)

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The Independent Drug Information Service
Program Director
Boston

The opportunity: This is a unique opportunity to become a key participant in the leadership of an organization on the forefront of health care transformation. The Independent Drug Information Service (iDiS) is a non-profit program that educates physicians about the comparative effectiveness, risks, and costs of prescription drugs. iDiS synthesizes and delivers evidence-based information on optimal prescribing to  physicians through educational outreach visits (“academic detailing”) by nurses, pharmacists, and MDs in several states (see www.RxFacts.org). This approach is an increasingly important component of quality improvement and health care reform at the local, state, and national levels. As the premier academic detailing organization nationally, iDiS is governmentally supported and is not affiliated with any pharmaceutical manufacturer in any way. Its mission is to provide physicians and patients with objective, unbiased, non-commercial information about prescription medications. Building on its strong reputation and experience, iDiS is well positioned for growth and increased visibility.  

The position: Reporting to the clinical advisory board, the iDiS Director will oversee program operations in Massachusetts, Pennsylvania, Washington, D.C., and future sites of work, and be accountable for the organization’s overall management and performance. The Director will have key responsibility for identifying and evaluating new program opportunities and for the continuous development of its core programs and services, and will collaborate closely with clinical consultants from Harvard Medical School and other institutions. S/he will also be an external face for the organization, cultivating and maintaining communications and collaborations with other organizations and funding sources.

Qualifications: The successful candidate will be an experienced leader who is a good relationship-builder and effective implementer, a data-driven manager who can provide structure and organization to a geographically dispersed field force. A background in primary care is preferred; clinicians with other backgrounds (including nurses and pharmacists) will also be considered, as will experienced medical administrators. The Director will work with a close-knit team in a modern office in Boston’s Back Bay. The position can be combined with part-time clinical responsibilities. 

To apply, submit a resume and cover letter to Jerry Avorn, M.D. at jobs@alosafoundation.org We also welcome nominations and requests for information to the same address.The Independent Drug Information Service is an equal opportunity employer.

(Posted 8/16/10)

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Health Plan
Vice President of Managed Care
Florida

Responsible for the day-to-day operations of Florida Managed Care health plan including Medicare and Medicaid lines of business. Assures timely reporting of required information to the Managed Care Division, Finance Department, Managed Care Executive Committee, Senior Management, Board of Directors and contracted private and/or governmental agencies.  Assures all contractually required reports from the Florida lines of business are submitted to the appropriate agencies Develops relationships with key service providers and vendors to facilitate collaboration and growth of the managed care programs. Ensures the annual Business Plan is implemented and monitored, including documented departmental and overall managed care goals and objectives.  Oversees the management of all departments operations. Provider Relations, Contracting and Network:  Quality Improvement, including Credentialing, Development/Maintenance, Claims Administration, Member Services, including enrollment/disenrollment and regulatory required member and provider materials.  Utilization and Case Management, Clinical Compliance and Informatics, Medical Director/Medical Management policy, MIS managed care operations

Education and Experience

Bachelor’s degree in Health Care, Public or Business Administration or related field required.  Masters degree preferred.  Minimum 10 years experience with managed care overall, with at least 5 of those years in a management role.  A background in Medicaid or Medicare managed care strongly preferred. 

Contact: ES&P-Sonia Varian at 818-707-7118, or espsonia@pacbell.net

(Posted 8/4/10)

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Windsor Health Group, Inc.

Actuary

Brentwood, Tenn.

POSITION DESCRIPTION, DUTIES & RESPONSIBILITIES:

• Work closely with Director of Medical Economics to develop tools and reports to analyze Medicare Advantage and Part D plan pricing and experience
• Develop and review annual plan bids in conjunction with outside actuarial firm
• Review of monthly reserve estimates and certification of reserves for statutory filing purposes
• Assist in review of provider contract pricing

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor’s Degree in Applied Mathematics, Actuarial Science, Statistics, Economics or a related field
• Fellow/Associate of the Society of Actuaries (FSA/ASA)
• Minimum of 5 years of healthcare actuarial experience
• MUST have at least 2 years of Medicare Advantage and/or Part D actuarial experience that includes CMS bid development
• Strong written and verbal communication skills
• Proficient in Microsoft Access and Excel, SQL programming helpful

Please send resume and salary requirements to resumes@whptn.com.

(Posted 8/4/10)

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CatalystRx
Client Services Director
Des Moines, Iowa

A bachelor’s degree and 3+ years related experience preferred or an equivalent combination of education and experience considered in the PBM industry with specific emphasis on client implementation and account management and proven success in the healthcare, managed care or pharmaceutical industries.  Drug knowledge a plus.  Must have strong management, implementation, communication and interpersonal skills.

Contact Lisa Calla-Russ at 240-268-3184 or lcallaruss@catalystrx.com

(Posted 8/2/10)

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CatalystRx

Clinical Consultant

Lansing, Mich. or Des Moines, Iowa

The Clinical Consultant serves as the primary liaison between Catalyst Rx Clinical Operations and Customer Service providing clinical support to Client Services, Operations, IT and Customer Service Pharmacy Technicians, claims processing system, and plan development as it relates to clinical operations; functioning as a Clinical Account Manager for assigned client accounts.

Qualifications include a Bachelor’s Degree in Pharmacy or PharmD, current state pharmacy license and 2+ years pharmacy practice experience in a managed care environment, including experience developing formularies, presenting at P&T committee meetings and performing drug utilization analyses; or equivalent combination of education and experience.  Strong communication, interpersonal, presentation, customer service and computer skills required.

Contact Lisa Calla-Russ at 240-268-3184 or lcallaruss@catalystrx.com

(Posted 8/2/10)

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Mercy Physician Group

Chief Financial Officer/Finance Director

Janesville, Wis.

Mercy Health System (MHS), Janesville, Wisconsin is a comprehensive health care system operating in two states, consisting of three hospitals, two nursing home facilities, a fully owned and operated insurance company, home health care and hospice services, retail health care services and 34 physician clinics, with 270+ employed physicians.

Witt/Kieffer, the nation’s largest executive search firm dedicated to the identification of leadership solutions in healthcare, has been retained to identify candidates qualified for the position of:

Chief Financial Officer/Finance Director

Mercy Physician Group

The culture of MHS is unique–focused on collaborative decision making, high accountability and service excellence. Its success is reflected in the stability and tenure of senior leadership.  This position is vacant due to the promotion of the prior incumbent to the system CFO position.  Growth of demonstrated internal talent is a key organizational value. 

The CFO will focus on working with the operations team to maximize clinic performance and growth.  Candidates must be comfortable with detailed financial analysis, report generation, direct interaction with physician colleagues and a collaborative approach to clinic performance excellence. 

Requests for additional information, nominations or resume submission to Christine Mackey-Ross c/o Witt/Kieffer, 8000 Maryland Avenue, Suite 410, St. Louis, MO. 63105; phone: 314-862-1370 or fax: 314-727-5662.  Electronic communication is preferred to MercyCFO@wittkieffer.com.  All inquiries will be handled confidentially.

Mercy Health System is committed to the policy that all persons shall have equal access to employment, programs, and facilities without regard to race, color, religion, sex, age, national origin, handicap, or any other prohibited basis. 

(Posted 8/2/10)
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Windsor Health Group, Inc.

Medicare Compliance Auditor

Brentwood, Tenn.

POSITION DESCRIPTION, DUTIES & RESPONSIBILITIES:

• Assist in establishing detailed audit programs to monitor and assess Medicare health plan operations and policies and procedures within all major functional areas including: medical management, network management, contracting, sales and marketing, customer service, compliance, enrollment and eligibility, and claims processing
• Perform audits within all major functional areas previously described
• Perform oversight and monitoring of outside contractors and delegated entities to report on compliance with company and regulatory policies and procedures
• Prepare audit reports with details of findings and proposed corrective actions, when necessary
• Utilize appropriate statistical methods and standard auditing procedures when appropriate (determination of appropriate sample size, random selection, establishment of materiality levels)
• Work with quality & compliance departments to develop baseline data in order to identify outliers and trends
• Stay abreast of developments in industry auditing standards as well as applicable federal and state guidelines, policies and procedures
• All other duties as assigned

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor’s degree and/or at least two years of experience in compliance, government programs or internal audit in a health insurance company or a related health care company.
• Medicare Advantage and Part D Prescription Drug program expertise desired, including understanding of compliance requirements, monitoring guidelines, and regulatory standards
• MUST enjoy and be able to multi-task in a very fast-paced organization with little direct oversight
• Knowledge of standard health plan organizational structures, workflows and operating procedures helpful
• Ability to communicate effectively, both orally and in writing
• Ability to analyze complex non-financial data and develop meaningful reports for internal and external use
• Experience in the development of effective audit programs and the use of standard auditing techniques
• Ability to effectively utilize Microsoft Excel and Access to track and manipulate data
• Occasional regional travel may be required
• Must be able to work occasional overtime during peak times or to meet regulatory deadlines.

Please send resume and salary requirements to resumes@whptn.com.

(Posted 7/26/10)
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Windsor Health Group, Inc.

Compliance Specialist/Sr. Compliance Specialist

Brentwood, Tenn.

Three (3) openings. Level of offered position will be based on qualifications and experience.

POSITION DESCRIPTION, DUTIES & RESPONSIBILITIES:

• Serve as primary compliance subject matter expert and point of contact for assigned departments
• Review departmental policies and procedures for completeness and adherence with CMS and other applicable regulatory guidelines
• Provide regulatory guidance distribution and interpretation and monitor the implementation of required changes for assigned departments
• Ensure regulatory compliance and accuracy of all departmental marketing materials and submissions in accordance with related guidelines
• Conduct departmental oversight activities and assist with internal audits
• Assist in the development and implementation of relevant compliance training programs
• Provide assistance in preparation for CMS and other regulatory audits as well as tracking of any follow-up or CAP requirements for assigned departments
• Work with CMS and other regulatory officials on departmental compliance issues as needed
• Create and compile ongoing departmental compliance reports to identify and monitor trends and significant compliance issues as assigned
• All other duties as assigned

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor’s degree and/or minimum of two years of experience in compliance or government programs in a health insurance company or a related health care company
• Medicare Advantage and Part D Prescription Drug program expertise highly desired, including understanding of compliance requirements, manuals, and regulatory standards
• Demonstrated skill and experience in researching and interpreting statutory and regulatory requirements
• Ability to manage demanding tasks with organization, attention to detail and thoroughness
• MUST enjoy and be able to multi-task in a very fast-paced organization
• Excellent written communication skills
• Knowledge of standard health plan organizational structures, workflows and operating procedures helpful
• Ability to effectively interact and communicate with regulatory officials and employees at all levels of the organization
• Must be able to work occasional overtime during peak times or to meet regulatory deadlines
• Proficient with Microsoft Office applications, particularly Excel and Word

Please send your resume and salary requirements to resumes@whptn.com

(Posted 7/26/10)
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Pfizer Inc.
Senior Manager (P5), Enterprise Infrastructure Architect

New York City

Primary Responsibilities include the following:

• In collaboration with Biz App line architects and Service Design & Build engineers, accountable for infrastructure strategy and roadmaps in the following areas: Servers, Storage, Authentication, and High Availability & Disaster Recovery
• Directs process to deliver a comprehensive application infrastructure design for Biz App line architects, promotes conformance with standard service offerings, and identifies and remediates exceptions.
• Works closely with the BT Shared Services Engagement Partners as liaison between Business Application Architects and Technology Infrastructure Architects.
• Collaboration and Communication to external stakeholders (e.g Strategy & Planning, BASDD, strategic and line architects)

Qualifications:

• BS/BA in Technical or Business field with a minimum of 12 years of experience in IT.
• Masters in Business or IT or equivalent experience
• Lean Six Sigma and/or ITIL training or certification a plus
• Well respected and very collaborative with a high degree of business focus. Expert at translating business requirements into technical solutions and vice versa.
• Anticipates Customer and Market Needs
• Strategic & Innovative Thinking

Technical Skill Requirements include the following:

• Deep technical knowledge in one of the following areas: Server or Storage. Able to apply extensive technical expertise across major technical areas.
• General knowledge across infrastructure services, including Server, Storage, High Availability/DR, Identity Services, and experience integrating applications.

Pfizer Core Competencies (list only 3-5 competencies)

• Acts Decisively
• Seizes Accountability
• Change Agile
• Commits to “One Pfizer”
• Peer Relationships

 At Pfizer, we've long recognized that our colleagues are our most important asset. We value our colleagues, recognize their talent, encourage their growth and reward their performance. It's a terrific environment that enables people to contribute, to do their best, and to achieve their potential.

Throughout our history, a legacy of caring for others has been at the heart of everything we do at Pfizer. This commitment is no less important when it comes to our employees.

When you choose a Pfizer career, we provide the resources to help you develop and succeed both in your career and your personal life. One way we can achieve this is through our comprehensive benefits program, which offers employees and their eligible dependents the variety and flexibility to help address their needs at different stages in life.

Pfizer Inc: Working together for a healthier world

Founded in 1849, Pfizer is the world's premier biopharmaceutical company taking new approaches to better health. We discover, develop, manufacture and deliver quality, safe and effective prescription medicines to treat and help prevent disease for both people and animals. We also partner with healthcare providers, governments and local communities around the world to expand access to our medicines and to provide better quality health care and health system support. At Pfizer, colleagues in more than 90 countries work every day to help people stay happier and healthier longer and to reduce the human and economic burden of disease worldwide.

HOW TO APPLY:

Please copy and paste the following URL into your browser address bar:

http://posttrak.arbita.net/cgi-bin/PostTrak.cgi?RefCode=R4842456008647

Posted 7/23/10)
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The Burchfield Group

Sales Vice President (Large Employer Market)

St. Paul, Minn.

The Sales Vice President reports to the Sr. Vice President of Business Development and resides 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 Sales Vice President will drive new business and relationships to tailor solutions for the prospective market.  QUALIFIED CANDIDATES MUST HAVE HEALTHCARE EXPERIENCE SELLING DIRECT TO LARGE EMPLOYER GROUPS.

Please contact Erica at eedgar@cor3talent.com

(Posted 7/16/10)
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UCare
Federal Government Relations Manager
Minneapolis, Minn.

UCare is an independent, nonprofit health plan providing health coverage and services to 200,000 members in Minnesota and western Wisconsin. 

We are currently recruiting for a Federal Government Relations Manager to lead all contract oversight activities for the Centers for Medicare & Medicaid Services (CMS) contracts and the Minnesota Department of Commerce (DOC) contract. The Federal Government Relations Manager will oversee regulatory and contract communications with CMS; communication of Medicare Advantage and Part D regulatory changes; writing of Federal member materials owned by the department; the material review and submission process; and CMS new and expansion applications for Medicare Advantage, Part D, and SNPs. The person in this position will serve a key role in product strategy recommendations for federal products and act as the lead on CMS non-financial site visits and DOC audits. This role also manages the Federal Government Relations team.

This position requires five to seven years related experience in a health care delivery setting (i.e. managed care organization, regulatory agency, or health insurance) is required. Comprehensive knowledge of Medicare, including government regulations is essential. Project management experience and a minimum of two years supervisory experience are also required. Knowledge of Medicaid managed care is strongly preferred.  A bachelor’s degree in a related field is preferred, however equivalent experience in the health care industry will also be considered.

Our selected candidate will receive a $5,000 sign-on bonus.

To learn more and apply online, please visit www.ucare.org

EEO Employer

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Confidential

Data Analytics Consultant

Chicago

Description:   Consultant, Analytics and Informatics Support

This Chicago based operation consulting firm is looking to hire a motivated, flexible individual to join our team in an analytic and informatics role serving our clients in healthcare, legal, financial services, and various other industries. This is a mid to high level position with exceptional opportunities for growth into a Director role.  The Consultant will be responsible for supporting various projects while learning and working within our methodology for delivering value to our clients.  Consultant will also be responsible for managing the knowledge acquired as a lead for Analytics and Informatics Support across projects, and developing a means to share this knowledge across the firm.  Ultimately, the Consultant will be responsible for demonstrating in-depth practice knowledge and skills and will be accountable for the successful execution of project goals and analytical deliverables. 

Teamwork and Client Focus:

• Consultant will work closely with Managers and/or Directors and consulting team staff on projects, contributing to team deliverables and assuming proactive responsibility for areas of expertise.  We require our team members to communicate often with peers, superiors, and other stakeholders with a client focus and positive, "can do" mentality.   Over time, we expect all employees to coach and mentor others, while sharing technical and functional knowledge (including training when necessary) as well as general professional experiences.

Primary Responsibilities:

• Organizes, sorts, filters and manipulates large data sets, consolidating data from multiple systems, analyzing in order to distinguish patterns and recognize trends, and synthesizing data into clear presentation to communicate outcomes and findings (verbal and written)
• Develops and maintains data preparation and validation routines to support data mining
• Selects, recommends and applies appropriate analytic methodologies and techniques to execute against an analysis plan or research objective
• Evaluates new analytics tools and methodologies for possible deployment
• Supports overall company cost reduction and data analytics methodology

• Works on client teams to deliver the highest quality data analytics, strategic thinking, and client deliverable support materials
• Uses critical problem solving skills to deliver a hypothesis-driven approach to solving strategic questions
• Understands the data and resources required to complete the analysis
• Anticipate client and client team needs to ensure delivery within tight timeframes 

Requirements:

• Bachelors degree with a strong GPA and demonstrated leadership skills.
• Concentration in Accounting and/or Finance preferred
• 1 to 3 years of analytic work experience with a leading professional-service firm
• Top Tier management consulting or “Big 4” Firm strongly preferred
• Excellent knowledge in MS Access and SQL Server 2000 or beyond
• Experience with other relational databases such as Oracle, Sybase is a plus 

• Knowledge/ Familiarity with Business Intelligence (BI) software applications such as Business Objects, Crystal Reports, COGNOS
• GUI development skills using VB/ VBA, .NET is a strong plus
• Very strong Microsoft Excel modeling, Access and PowerPoint presentation skills
• Strong track-record of problem-solving, including structuring problems, performing detailed analysis, and developing recommendations
• Knowledge of and experience with basic financial statements & complex data analytics
• Strong communication skills, including written and interpersonal skills
• A “can do”, team-oriented attitude demonstrated by energy, determination and professionalism
• Enthusiasm for joining a fast-paced, high growth company
• Ability to advance from the consultant role to a management position over time
• Willingness to travel as required

Preferred Assets, but Not Required

• Advanced degree or CPA, MBA, MPH, MHA, etc.
• Experience in health plan/payer environments
• Familiarity with healthcare administrative data and healthcare service analytics methodology 
• Experience in creating complex data mining algorithms

About the company

We are a privately held management consulting firm specializing in the operational performance of service sector organizations.  Our team was established within a large public accounting firm and is now led by a management group who has worked together since 1996.  Our Managing Directors average 20+ years of professional experience working with mid and large-sized organizations and provide the core breadth of expertise utilized to serve our clients in three primary areas:  Strategic Operations, Finance and Accounting, and Information Analytics.

Please contact Bethany Priester at 312.493.8103 to further discuss this position.

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Vermillion Group
Regional CMO
Tampa, Fla.

Oversees all medical and clinical assessment activities for the state. Functions as liaison with physicians, providers, and community health-related organizations. Provides professional and analytical support to peer clinical reviewers, QM/UM committee and department staff. Supervision of multiple medical directors. In addition, work with Corporate Group in new business development opportunities and other related activities as needed.
Must be licensed MD or DO, board certified in a primary care specialty.

Managed care experience required.

For confidential consideration please email your resume to  tpw@vermilliongroup.com Only qualified candidates will be contacted.

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DST Systems/Argus Health Systems
CMS Regulatory Compliance Manager
Kansas City, Mo.

CMS Regulatory Compliance Managers demonstrate a thorough knowledge of CMS regulations and proposed regulations. They supervise associates responsible for ensuring the company’s Medicare/Medicaid product and service offerings and internal technology are compliant with federal and state CMS regulatory requirements and are meeting or exceeding the company’s performance benchmarks. They recommend Medicare/Medicaid product and service enhancements and review and/or assist in developing functional/business requirements for technical enhancements and new product and service offerings. CMS Regulatory Compliance Managers make decisions using independent judgment that have significant customer exposure and company liability when interpreting federal and state CMS regulations. For the most complex interpretations, they consult with industry resources and CMS regulators to clarify and/or verify the accuracy of their interpretations. CMS Regulatory Compliance Managers establish and maintain effective business relationships with CMS regulators, third-party advisors, and other business partners/vendors. They investigate and resolve complex compliance issues and communicate with CMS regulators as appropriate. They coordinate site visits for regulators and coordinate implementation and compliance with corrective action plans, as needed. CMS Regulatory Compliance Managers analyze and identify CMS regulatory, financial, and operational risk for the organization. They develop and/or recommend CMS compliance-related policies and procedures and assist with audits or compliance reviews of operational areas against documented procedures. CMS Regulatory Compliance Managers develop training materials on CMS regulatory compliance subject matter and the business impact thereof; they facilitate training and lead customer forums. Supervisory responsibilities include, but are not limited to, interviewing, making hiring recommendations/decisions, delegating work assignments, conducting performance appraisals, assisting with career planning, and enforcing company policies. They contribute to budget planning and may assist with monitoring a departmental budget.  Desired Skills: Medicare Part D expertise strongly preferred

DST offers a complete benefits package, which includes paid medical and dental insurance, relocation assistance, educational reimbursement, and more.

Please apply online at www.dstsystems.com/jobs using Job Req#8697

AA/EOE

No Agencies Please

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Health Plan
Vice President Compliance
Smyrna, Ga. 

Ensure regulatory compliance with state Medicare, Medicaid program and state health care cost containment activities for the state health plan, of the Corporation and its business subsidiaries. Develop policies, procedures and processes to comply with state law, federal law and state contract requirements. Train health plan staff of new policies, procedures and processes to comply with new state law, federal law and state contract requirements.
Requires a Bachelor's degree in Public Policy, Government Affairs, Business Administration or equivalent. At least 5 years of relevant experience. Extensive knowledge of state administrative code and regulations, Experience with state and federal government agencies, accreditation bodies. Master’s or Law degree preferred. Current Management experience required. (Will Relocate)

 Contact: ES&P-  Sonia Varian at 818-707-7118, or espsonia@pacbell.net 

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Health Plan
Vice President Operations
Jackson, Miss.

Perform duties as chief liaison between the identified region and Corporate policies & standards. Facilitate operational oversight for multiple departments and identify opportunities for maintaining the most cost efficient operation.  Identification of operational efficiencies; meet regulatory and client expectations and develop a “best practice” approach to all operations. In support of the overall strategic plan, establish operational strategic vision, objectives, policies and procedures for the Plan.  Meet and exceed requirements including organizational, state, compliance and contractual agreements.  Bachelor's degree in Business Administration, Healthcare Administration or equivalent. At least 8 years of experience in Management, Administration or Operations in the Healthcare or Insurance industry. Master’s degree preferred.  (Will Relocate)

Contact: ES&P-  Sonia Varian at 818-707-7118, or espsonia@pacbell.net

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Health Plan

Vice President of Medical Management

Jackson, Miss.

Perform duties to direct and coordinate the medical management, quality improvement and credentialing functions for the assigned health plan based on, and in support of the company’s strategic plan; establishing the strategic vision and attendant policies and procedures.  Direct and coordinate activities of department and aid the chief officer of the health plan and appropriate corporate staff in formulating and administering organizational and departmental policies. Equivalent to a four (4) year education in nursing.  Advanced education in nursing, health care, business or public administration preferred. Familiarity of case management practices, managed care, and Medicaid programs. (Will Relocate)

Contact: ES&P-  Sonia Varian at 818-707-7118, or espsonia@pacbell.net

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Healthfirst
Healthcare Analyst
New York and New Jersey

Healthfirst was established in 1993 and is managed by some of the most prestigious and nationally recognized hospitals and medical centers in New York. We are one of the fastest growing health plans with over 480,000 members and a network of more than 19,000 providers.

Our mission is to provide affordable, quality care for the communities we serve and improve the effectiveness of healthcare delivery by partnering with providers and reinvesting in our member hospitals

Position Summary:

The Healthcare Analyst, Hospital Reporting will be responsible for overseeing financial performance of owner hospitals, preparing yearly financial reviews and communicating financial results and areas of opportunity for Healthfirst senior management and hospital staff..

Essential Duties and Responsibilities:

For consideration of this and all Healthfirst job listings, please apply on-line at www.healthfirstny.org.

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AIDS Healthcare Foundation
Compliance Officer
West Hollywood, Calif.

Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our nonprofit mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.

We are currently seeking a Compliance Officer. The position is based out of our Managed Care Administrative Office in West Hollywood, California. We offer a competitive salary and great benefits.  The office hours are Monday-Friday, from 8:30 a.m. to 5:30 p.m.

AHF and its affiliate AHF MCO of Florida, Inc. (collectively “AHF”) have a number of managed care plans and programs for people with HIV and AIDS. Currently, these plans/programs operate in California and Florida, and may expand to other states. The Compliance Officer’s role is to oversee AHF’s compliance program for all of AHF’s managed care lines of business: Medi-Cal, Medicare Advantage/Part D, Florida Medicaid, and Ryan White CARE Act.

ESSENTIAL DUTIES & RESPONSIBILITIES INCLUDE BUT ARE NOT LIMITED TO:

• Chairing bi-monthly Compliance Committee meetings to review and discuss compliance-related issues.
• Making sure AHF timely reports to all applicable external regulatory agencies (i.e., DHCS, DMHC, CMS, AHCA, OIR, OAPP) by, among other things, maintaining up-to-date schedule of reporting to all regulatory agencies; timely reminding responsible parties of upcoming reporting deadlines; filing required reports and maintaining records of filed reports.
• Providing reports on a regular basis, and as directed or requested, to keep the Board and senior management informed of the operation and progress of compliance efforts.
• Daily reviewing guidance issued by regulatory agencies (i.e., HPMS memos, DHCS all-plan letters, AHCA newsletters) and promptly summarizing and distributing summaries and guidance to appropriate managed care staff.
• Implementing annual work plan of compliance-related activities 
• Implementing annual staff trainings regarding compliance issues (fraud/waste/abuse, HIPAA, red-flag).
• Drafting and updating compliance policies and procedures.
• Monitoring managed care departments for compliance with AHF managed care contracts and governing regulations and, in cooperation with Chief of Managed Care, developing any needed corrective action plans.
• As required, attending conference calls, user calls, and outside compliance trainings/conferences by regulatory agencies (i.e., CMS).
• Leading preparations for audits by government agencies.
• Implementing and/or overseeing internal audits managed care operations (i.e., finance, claims, appeals/grievances).
• Acting as liaison between AHF and agency contact persons (as required).
• Managing the daily operation of the compliance program.
• Maintaining an “open door” policy for staff with compliance issues/concerns.
• Investigating compliance issues in conjunction with General Counsel.
• Conducting periodic risk assessments.

EDUCATION AND/OR EXPERIENCE

• Doctorate degree (J.D.) or equivalent with an emphasis in healthcare law or a BA and more than 3 years of health care compliance-related experience and/or training.
• Would you like to learn more?  If so, please send your resume via e-mail to: arlette.delacruz@aidshealth.org or fax it to: (323) 467-8450.  To apply in person please come to our Administrative Office: 6255 Sunset Blvd., 21st. Floor, Los Angeles, CA 90028.

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Gorman Health Group
Senior Consultant
Washington, D.C.

The Senior Consultant participates in various consulting engagements by providing subject matter expertise with respect to Medicare Advantage (Part C) and Prescription Drug Plan (Part D) compliance, regulatory issues and requirements.  In addition, the Senior Consultant provides a high level of support and guidance with respect to software solutions offered by Gorman Health Group (GHG) to clients and prospective clients. The Senior Consultant demonstrates a high level of knowledge, skill and experience in evaluating compliance to CMS audit elements.  The Senior Consultant will have 5-10+ years of experience working with the Medicare managed care program. A Bachelors degree or equivalent experience is required and a Masters degree is preferred.  The Senior Consultant must be able to travel up to 60-70% of the time, including some weekends.  Strong proficiency with MS Office Suite is required.

Send your resume and cover letter to jobs@gormanhealthgroup.com.

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CardiaCall, LLC
Cardiac Event Monitoring Sales Representative (Service and Device Sales)
South Florida

CardiaCall, LLC is a fast growing cardiac event monitoring device sales and service company for physicians (Electro Physiologists, Cardiologists, Internists, etc.) and their patients, headquartered in South Florida.  CardiaCall’s unique approach to cardiac event monitoring provides physician and patient solutions in cardiac monitoring care that is unmatched in the industry.

CardiaCall provides the highest level of technical and personal care with creative, innovative solutions for the customary 30-day cardiac event monitoring prescriptions, enabling physicians to enhance the level of patient care. In addition, our business model is tailored to potentially increase the physician’s event monitoring income significantly in comparison to conventional cardiac monitoring programs.  We also offer a continuing private-pay annual monitoring service that provides patients with expanded control over their health care while, simultaneously, creating an additional monthly/annual revenue stream for the prescribing physician.

This is a highly-visible position within the company, offering the opportunity for advancement, benefits and uncapped commissions!

Job Description:

• Responsible for planning and developing device and service sales through focused sales activities and providing extraordinary customer service.

• Develops relationships with physicians, their office staff, hospital associates and other referral sources.

• Professionally promotes the product and services CardiaCall offers.

• Networks with other sales representatives to increase database of contacts, customer support and aggressively builds sales.

• Provides a comfortable environment to educate physicians about the benefits our service provides.

Proven track record of Sales success, as well as a relevant list of existing contacts within the medical industry (cardiology focused) a must.

Qualifications:

• Minimum 2 years of successful outside sales experience.

• Strong, existing network of physicians who treat cardiac patients throughout your region is imperative.

• Must be hard working, self-motivated, independent individuals.

• We seek common-sense individuals who have the desire to help others and contribute to the growth of our business.

• Demonstrated stable career with a track record of success in Sales; specifically medical device sales.

• Excellent verbal communication skills with the ability to speak in small group settings.

• Must be able to keep accurate records of daily activities and results.

• Strong organizational skills a must.

• Requires the ability to provide great service to customers.

• Must be comfortable in the physician’s office or hospital setting.

• Ability to develop and maintain strong relationships with physicians, their facility and medical personnel.

• Valid Driver’s License and reliable transportation required.

• Must be eligible to work for organizations who participate in federal health care programs, including Medicare and Medicaid programs.

CardiaCall, LLC offers a highly attractive commission based payment structure.

Please send your cover letter and resume to info@cardiacall.com or fax to 954.483.2060.

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Confidential
Program Manager
N.Y., N.J., Conn.

Company:

Our client, a provider owned, not-for-profit, government programs organization based in the tri-state area, is looking for a Program Manager to manage high level cross-functional projects for the company. 

Responsibilities:

He/she is responsible for managing projects through the entire project lifecycle including project definition, project planning, execution and control, and project closeout.  He/she will manage the activities of project personnel to ensure that project milestones and completion dates are met. This position will be responsible for delivering high quality and cost effective project management, management consulting, and analytic support services. Other responsibilities include, design, develop and maintain project management activities associated with assigned projects.  Responsible for ensuring all key aspects and features of project designs are effectively implemented.  Determine project requirements for resolution of business issues and changes affecting the design of the project.  Maintain budget responsibility for each assigned project.  Ensure that requirements are addressed and/or incorporated into the project and are part of the ensuing process solution.  Support the business strategy requirements for all project implementations.  Acts as a central coordinator for cross functional project team. Deliver regular project status and achievement information to the appropriate management. 

Qualifications:

The best candidates will have five or more years project management experience, demonstrated experience in managing large scale projects and influencing, driving and managing organizational change. Experience in financial analysis, financial modeling and strategic projects in a healthcare or financial services setting is a plus.

Undergraduate degree required, master’s degree in Healthcare or in a Business related discipline preferred. PMI certification or Management consulting experience a plus

Please contact Robert Prufeta, Solomon-Page Group in complete confidence at rprufeta@spges.com

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