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

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