Search- Manager Provider Relations|East Coast Location

Pam Ratz DeVille, Executive Consultant with Managed Medicaid Services announces a search for a Manager of Provider Relations. Managed Care Organizations are expanding rapidly to meet growing demand and they look to Pam to help them attract the top talent from the industry.
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Contact Pam today to set up a confidential conversation.

 

 

Pamela Ratz DeVille, CPC, CIR, CDR |http://www.linkedin.com/in/pamratzdeville
866-371-0687 X 256 office
PamD@medicaidservices.net

Manager Provider Relations

Foster collaboration with the provider community as the Manager of Provider Relations. A strong leader with a desire to stay innately connected to the requirements of state and federal health programs will stand out as a prime individual to enhance and develop the team at this growing Managed Care Organization.

Duties Include:

– Responsible for maintaining existing and developing new provider relations, and assisting with contracting activities.
– Manage the staff in contracting area including work flow, training and communication standards.
– Manage day-to-day provider relations activities and provider relations department.
– Develop, implement and maintain production and quality standards for the contracting staff.
– Monitor and analyze costs and prepare departmental budget.
– Initiate and execute standard physician and ancillary provider contracts.
– Coordinate all pre-contract activities with providers such as, site visits, credentialing, orientation to contractual requirements, etc.
– Maintain contracts and correspondence files in organized and accessible manner for all providers.
– Prepare and analyze information to evaluate the need for additional health plan providers.
– Manage and coordinate customized provider contracts and hospital contracts.
– Participate in physician and ancillary provider contracting and provider relations in foreign state markets through implementation and startup phases.

Knowledge/Experience:

Bachelor’s Degree or equivalent experience. 4-6 years of Managed care or health delivery system experience including project and staff management experience. Experience with state and federal health programs such as Medicaid and Medicare. Provider relations/contracting experience including solid communication and negotiation skills.

VP Compliance | AZ | Search

Growing specialty health company! Ensure regulatory compliance with state and other government agencies related to the health insurance industry, corporate and its business subsidiaries. Ensure business unit and corporate are in compliance with state and federal program regulations insurance regulations regulatory requirements for business entities and state contract requirements. Maintain and track laws and regulations contract documentations amendments and various compliance measures. Develop policies procedures and processes to comply with state law federal law contract requirements and various standards. Oversee administer and implement various compliance programs including fraud and abuse and HIPAA. Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language. Conduct compliance audits develop and implement corrective action plans and report on achievement of action plans to senior management. Develop strategic relationships with state legislative policymakers and assist with the development of state legislative public policy concerning state insurance Managed Care Organization Medicare and Medicaid regulations and initiatives. Identify evaluate and analyze the impact of state legislative and regulatory issues and advise management concerning impact. Represent senior management at various committees meetings and seminars

Position requires a Bachelors degree in Public Policy Government Affairs Business Administration or related field. 5+ years of compliance program management and contract experience. Extensive knowledge of state administrative code and regulations state insurance laws and regulations including managed care regulations. Experience with state and federal government agencies accreditation bodies participating provider agreements HIPAA and Third Party Administration (TPA) laws credentialing regulations and prompt pay laws. Master’s or Law degree preferred.


APPLY HERE

Executive Recruiting Contact:
Pamela Ratz DeVille, CPC, CIR, CDR
DL: 866-371-0687 x256
PamD@MedicaidServices.net

VP Medical Management |Washington | Search

Select your own team to grow and develop! Establish and implement the strategic vision for all medical management and quality functions in WA. Review and analyze all activities, costs, operations and forecast data to determine department progress. Participate with executive committees on special studies. Administer and ensure compliance with NCQA and/or JACHO standards as determined for accreditation of the health plan. Participate in staff, departmental, committee, sub-committee, community, State and other activities, meetings and seminars. Get involved with provider education and contracting activity as appropriate.

Successful candidate will have Bachelor’s degree in nursing, or equivalent experience. 10+ years of clinical nursing, quality improvement, and management experience in a managed care setting. Thorough skills knowledge of quality improvement practices. Familiarity of medical information systems, medical claims payment process, medical terminology and coding. Familiarity of case management practices, managed care, and Medicaid programs. Familiarity of NCQA accreditation process and standards.

CLICK HERE TO APPLY

Executive Recruiting Contact:
Pamela Ratz DeVille, CPC, CIR, CDR
DL: 866-371-0687 x256
PamD@MedicaidServices.net

Sr. Clinical Systems Specialist| Informatics RN |Search

Tech-savvy RN will promote medical management processes and manage application integration throughout numerous areas of the organization to promote effective collaboration. Identify opportunities for process adjustments and redesign related to new business, new and existing programs. Formulate and manage work plans related to system or process initiatives. Direct and/or perform testing related to application upgrades and/or modifications. Maintain all aspects of the application described as clinical content. Monitor, analyze and coordinate resolution of large scale application issues related to the transfer of member and provider, and/or authorization data. Maintain MM web page for the Clinical System Management Unit. Work as a team with other RN’s performing similar work.

Bachelor’s degree in nursing, RN, 5-7 years of related experience. Project management in a clinical environment preferred. Ability to integrate nursing knowledge to enhance business optimization and application development. Ability to travel approximately 20%.

Executive Recruiting Contact:
Pamela Ratz DeVille, CPC, CIR, CDR
DL: 866-371-0687 x256
PamD@MedicaidServices.net

Apply Here

Chief Medical Officer | Search

EXECUTIVE PHYSICIAN will drive all medical management efforts, quality improvement and credentialing functions for the LA business unit. Successful candidate will serve as clinical advisor to and educator of medical management staff. Oversight of internal medical review guidelines to ensure clinical integrity and compliance. Responsible for regulatory accreditation concerns pertaining to medical management issues. Handles medical review activities pertaining to the complex, controversial, or experimental medical services. Facilitates the achievement of the Medical Management Program goals through an effective health services delivery system. Responsible for physician review and oversight of all potential adverse determinations including pre-certifications/prior authorizations, concurrent review and appeals/retrospective review. Responsible for HEDIS improvement and strategy. Actively participates in the auditing process of medical management processes and corrective action team projects for medical management. Achieves utilization, cost management and quality goals. Participates and advises in the development of corporate medical policies for UM, pharmacy, and new technology.

Position requires a Medical Doctor or Doctor of Osteopathy, board certified in a specialty recognized by the American Board of Medical Specialists. Previous experience as Medical Director required. Master’s degree in Business Administration, Public Health, Healthcare Administration or related field preferred. Strong preference for experience in LA.


Apply Here

Executive Recruiting Contact:
Pamela Ratz DeVille, CPC, CIR, CDR
DL: 866-371-0687 x256
PamD@MedicaidServices.net

Medical Director Search

Medicaid Medical Director Wondering

Medical Director Search

 

 

 

 

We wonder which are you?

The “start from scratch” or the “get it used and make it better” type ?

If you answered start from scratch we would love to connect to discuss our search for a Medical Director that would be excited to get in on the ground floor of a great opportunity.

If you are selected for this role..

You will have the exclusive opportunity to develop and lay the foundation for our client’s new midwest operations. Your years of Managed Medicaid experience will be crucial to the success our client has in providing quality care and benefits to thousands in this new market. This opportunity will allow you to draw upon your rich years of clinical and operations know-how while tapping into your ability to cultivate, encourage and sustain a strong productive team as a dynamic leader.

Executive, Physician, Leader, Expert….Would these be the correct words to identify you? Don’t be modest if this is you, then lets connect.

866-371-0687

Ready to apply? Click Here

Manager Medical Management | Search

Medical management and creative writing are the right combination of skills here.  Unique position will be instrumental in business expansion efforts nationally. Oversight for writing proposals from the med mgmt perspective, defining requirements, estimating and project planning for new business implementation and execution.    Creativity and professionalism will be essential in drafting proposals that adhere to established themes, writing guide and State, Federal and NCQA requirements. Research best practices, appropriate technological and logistical support. Will be instrumental in selecting and developing staff for new program implementation.

Must be able to travel for implementation of new business (varies 20-40%). Position requires nursing degree or Bachelor’s in related field, 3-5 years of writing experience including the ability to create business proposals and develop and implement business models. Project mgmt skills required. PMP a plus. Experience in managed care industry strongly preferred.

Executive Recruiting Contact:
Pamela Ratz DeVille, CPC, CIR, CDR
DL: 866-371-0687 x256
PamD@MedicaidServices.net

Click Here to Apply

Quality/Utilization Deputy Director Search

2012 is off to a fast start and great opportunities to further grow your career in the Medicaid industry are opening up with many of our clients.

Today we are launching a search for an experienced professional with utilization/quality experience to take over as Deputy Director of Medicaid Quality and Utilization.

Leading our client into 2012, you would assist in developing and implementing a utilization management program.  Key responsibilities would include the oversight of operations, case management, disease management and quality programs, as well as the oversight of systems and strategies that support accreditation of this health plan.

Build upon your clinical background and your expertise in building, organizing and motivating teams to improve health outcomes.

Interested in learning more? Contact us we would love to discuss.

Three Signs of a Miserable Job

By Tom Musbach

“Awful,” “dreary” and “miserable” are adjectives many people use to describe their jobs at one time or another. Dissatisfaction on the job is common and often temporary. But not many people take time to analyze what makes a job miserable, and how to fix it.

Fortunately Patrick Lencioni has done much of that work in his book, The Three Signs of a Miserable Job: A Fable for Managers (And Their Employees) (J-B Lencioni Series)

Job Misery Is Universal

The author notes that a “miserable” job differs from a “bad” job, as one person’s dream job may not appeal to another worker. A miserable job, however, has some universal traits.

“A miserable job makes a person cynical and frustrated and demoralized when they go home at night,” Lencioni says. “It drains them of their energy, their enthusiasm and self-esteem. Miserable jobs can be found in every industry and at every level.”

Lencioni blames much of the problem on managers, who are a key factor in the job satisfaction (or dissatisfaction) of their employees.

The Three Signs

Lencioni identifies the three signs of job misery as anonymity, irrelevance and “immeasurement.”

  • Anonymity: Employees feel anonymous when their manager has little interest in them as people with unique lives, aspirations and interests.
  • Irrelevance: This condition occurs when workers cannot see how their job makes a difference. “Every employee needs to know that the work they do impacts someone’s life — a customer, a coworker, even a supervisor — in one way or another,” Lencioni says.
  • Immeasurement: This term describes the inability of employees to assess for themselves their contributions or success. As a result, they often rely on the opinions of others — usually the manager — to measure their success.

Three Remedies for Job Misery

For workers who may be experiencing job misery, Lencioni recommends three steps to improve the boss-employee dynamic and enhance job satisfaction.

  • Assess Your Manager: Is the boss interested in and capable of addressing the three factors mentioned above?  “Most managers really do want to improve, in spite of the fact that they may seem disinterested or too busy,” Lencioni says.
  • Help Your Manager Understand What You Need: This could mean reviewing with your manager your job’s key measurements for success. Lencioni also suggests asking your boss, “Can you help me understand why this work I’m doing makes a difference to someone?”
  • Act More Like the Manager You Want: “Employees who take a greater interest in the lives of their managers are bound to infect them with the same kind of human interest they seek,” Lencioni says. Or find ways to let your manager know how his performance makes a positive difference for you.

Be Realistic

Richard Phillips, founder of Career Advantage Solutions, agrees that managing up is a good way to improve job satisfaction, but he cautions employees to have realistic expectations.

“Managers are not mind readers,” he says. “Take the responsibility to communicate upon yourself, and remember there has to be an ongoing dialogue, or change is unlikely to happen.”

Employee Retention Hot Topic for Business Leaders

Entrepreneurs and business leaders report employee retention is still on of their top 3 challenges.

A 2011 AFLAC Workforce Report found that 18 percent of business owners see the benefits package as a direct influence on an employee’s decision to leave.  The report lists voluntary benefits as a way to reduce costs and still offer quality benefits.

What is important to note, however, is that even in a recession and high unemployment, good people are willing to leave their jobs.  This makes solid employee retention strategies an essential part of every business opeation.  As the report states “it takes time and money to recruit, interview, train and hire a new employee.”  Buisnesses who don’t drive employee retention strategies from the top down are going to lose their competitive edge.

If your business doesn’t have a written and implemented plan to minimize employee turnover, today is the best day to start!