Case Manager Jobs – New Opportunity in WI

Out Client is Looking for You!

Strong and growing! This leading healthcare enterprise truly values their nurses. They offer innovative products and sophisticated analytic tools. An experienced RN with case management will enhance the continuing growth of the team in the WI market.

“We believe our nurse case managers are the backbone of our member’s care.”

Experienced case manager will assess, plan and coordinate continuum of care for select members with complex medical or behavioral health conditions or are at high risk in order to promote quality, cost effective care.

 

APPLY HERE

Search | Care Management Director

Are you a “roll up your sleeves and get it done” kind of leader?

An innovative, strategic and high impact Care Management Director can join one of the largest health care organizations in the US. Based in the mid-west, our client has been serving the Medicaid population for decades. They continue to be recognized as an innovator and one of the most admired companies in their state.

Listed as one the top places to work, employees enjoy a full range of comprehensive benefits, competitive salaries and bonuses, as well as community involvement and diversity. The company’s continued leadership in Medicaid creates significant opportunities for career advancement and personal and professional growth.

The High Risk Care Management Director will be the primary representative of the company in their city.   As the leader of this new program, the first responsibility is to further develop and implement the program. This includes creating partnerships with community based resources, presenting to organizations, and working with the Manager and field staff on a regular basis. In addition to program development, the Director will create and oversee a new staff development program. This will involve team and individual training across a wide variety of staff positions. Both the staff and program development responsibilities will result in this high risk care management program becoming the model for the industry. Additionally, the Director will also use their strategic and problem solving skills to assist the Vice President in special projects.

Care Management Directors with strong experience in program development are the first choice for this position. Expertise in care management protocols , experience in staff development, and experience in project management are equally prized by our client. This position is open to an RN, MSW, Clinical Counselor, or licensed Psychologist. Advanced business degrees or experience is also a plus.

Apply now to be considered. This kind of high-profile, career building position does not stay open very long!

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New Search: Chief Marketing Officer

Chief Marketing Officer

Primary Skills: Bachelor’s degree, Sr. Level Marketing Exceutive with Medicare Part D experience.
Description: The Medicare Part D Chief Marketing Officer will develop and implement marketing and communications strategies for enrollment, member communications and member retention. Utilizie multiple communications tools and channels. and work cross-functionally within the Marketing & Communications group and across the organization. Build and supervise a Medicare marketing team to support the growth of diverse markets.

Provide professional expertise on Medicare benefit design and the regulatory environment.
and build effective, strategic working relationships with product, sales, and regulatory leaders. Manages internal stakeholder expectations around marketing plans, messaging, priorities, budget, and time lines. Support various internal departments to develop communication plans for current Medicare members. Develops strategic and tactical marketing plans based on current business strategy. Serve as Subject Matter Expert on promotions, communications, event marketing and campaigns to develop and delivering targeted and effective messages to our target Medicare population. Work with Compliance Department to ensure all marketing communications are compliant with CMS guidelines and regulations. Works closely with retail and insurance company partners to develop and implement an Agent Sales strategy to support sales goals.
Assist with copy writing and reviewing of various marketing materials. Maintains CMS submission library of letters and other CMS communications. Manages submission process with CMS.

Requirements :
Extensive expertise with CMS, Medicare and Part D regulations. 4-year degree in Health Care Administration, Marketing, Business, Communications, or related field. 7+ relevant insurance company, PBM, health care payor, and/or government health plans. Experience in leading and partnering with cross functional teams to accomplish a common goal.

7-10 years relevant insurance company, PBM, health care payor, and/or government health plans

Case Manager |RN |IL |Search

Medicaid Case Manager RN

Medicaid Case Manager RN

Join an organization that TRULY values their nurses! This is a rare opportunity for an RN with experience in UR to step into a managed care setting with plenty of room for growth. Review inpatient admissions to assure appropriate level of care and medical necessity. This will be done on site and tele phonically. Audit patient charts through on-site hospital visits, act as clinical resource to referral staff and make appropriate referrals. Educate patients and providers. Enters assessments, authorizations and reviews into the system.

Position requires an RN with min. 2 yrs clinical exp and UR exp. Current state nursing and driver’s license.

Knowledge/Experience: At least two years clinical nursing experience.

APPLY HERE

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