| EMPLOYMENT OPPORTUNITIES |
Executive Positions with Managed Care Organizations
Interested Parties Please Contact:
Executive Search & Placement (ES&P Search)
Phone: 818-707-7118
For confidential consideration please submit resumes to Sonia Varian: espsonia@pacbell.net
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NEW POSITION: DIRECTOR, HEALTH ECONOMICS Excellent opportunity with a Health Plan Provide vision, strategy and operational leadership relating to the data integrity, tools and analysis of medical data needed to support company’s key business goals and objectives. Responsible the company’s health economics data relating to strategic goals and objectives. Provide analytical interpretation of medical data including comparative benchmarks for evaluation of clinical practices and the development of financial and contractual modeling. Direct the consolidation, organization, and manipulation of health information to support medical expenditure and utilization analyses. Identify risks and opportunities associated with future profitability, member retention, and clinical outcomes. Develop and maintain standards regarding the collection, manipulation, validation, and communication of data information. Conduct health data economic analysis for Medical Management, Finance, and Contracting/Network Development Departments to identify medical management strategies and network management strategic and operational opportunities. Prepare and distribute state-required and/or departmental reports related to health care quality improvement initiatives including HEDIS and disease management programs. Bachelor's Degree in public health, medical informatics, business, or related field and 5-7 years of data mining and construction of data warehouse experience. Experience with HEDIS, Medicare, MCO and/or Medicaid reporting preferred. Master’s degree a plus. |
Midwest | Will Relocate |
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NEW POSITION: DIRECTOR OF MEDICAL MANAGEMENT Responsible for the planning, developing and directing Utilization Management. Develop and implement measures and controls to achieve company’s goals. Directs all Utilization Management Department programs including authorizations, concurrent review and case management. Assists all staff, to assure that cost-effective, high quality options and solutions are pursued and implemented during the utilization management process. Supervises and assists staff to analyze, update and modify policies, standard operating procedures and processes to continually improve department operations. Develops and implements policies and/or programs that increase quality and cost effective utilization of health services. Assists staff with interpretation of department policies and procedures, benefit interpretation, and the implementation of criteria used in utilization management activities. Managed Healthcare and management experience. NCQA accreditation experience. BSN/BS/BA or Degree in Healthcare related field Master’s Degree in Healthcare is preferred R.N. with active unrestricted license CCM, QM/UM certification preferred. |
Arizona | Will Relocate |
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V.P. CONTRACTING Perform duties to coordinate, negotiate and handle activities of the contracting department and aid the Plan President in formulating and administering health plan policies and procedures. Plan, direct and implement, through subordinate management and staff, department activities. In support of the company's strategic plan, establish the department's strategic vision, objectives, and attendant policies and procedures for the organization. Partner with business unit leaders to identify and prioritize needs of the organization. Equivalent to four (4) year college education in healthcare administration, business administration, marketing or related field. Advanced degree preferred. Over (4) four years up to and including (10) ten years of provider relations/contracting management experience in a healthcare and/or managed care environment. |
Midwest | Will Relocate |
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V.P. NETWORK DEVELOPMENT & MAINTENANCE Responsible for developing and managing the provider network strategy for the Corporation. Lead all aspects of provider network strategy including, but not limited to reimbursement strategy, contracting strategy, unit cost management, claims configuration and network operations. Bachelor's degree in Business Administration, Healthcare Administration or related field. At least 10 years of experience in managed care network development. MBA or MHA degree preferred |
Midwest | Will Relocate |
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DIRECTOR HEALTH SERVICES Provide direct supervision for the daily operations of the Utilization, Referral and Chronic Care Managers and Solutions Unit Supervisor. Work effectively with corporate health services staff to implement state wide policies and procedures. Work with the Medical Director in overseeing medical policies, medical service delivery and quality of care for health plan members. Support provision of high quality, cost-effective clinical care in efficacious relationships with health care providers. Manage health plan risk effectively. |
South | Will Relocate |
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DIRECTOR OF QUALITY MANAGEMENT Responsible for the planning, developing and directing Quality Improvement functions. Provides leadership, management and supervision of department operations and staff, to ensure that the quality of healthcare services rendered meets or exceeds professionally recognized community standards. Develop and implement measures and controls to achieve company’s goals. Directs all Quality Management Department programs. Supervises and assists staff to analyze, update and modify policies, standard operating procedures and processes to continually improve department operations. Develops and implements policies and/or programs that increase quality of health services. Acts as a liaison to regulatory agencies. Is responsible for the department readiness and compliance with NCQA standards and other regulatory requirements. Develops systems for close coordination of QI related functions with departments whose activities are directly parts of the Quality Improvement Program. Establishes positive relationships with all local and corporate company departments. BSN/BS/BA or Degree in Healthcare related field Master’s Degree in Healthcare is preferred R.N. with active unrestricted license CCM, QM/UM certification preferred |
South | Will Relocate |
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DIRECTOR, BIOMEDICAL INFORMATICS The responsibilities of this position would include providing vision and direction to a well-developed department of 40 employees who work in the functional areas of Bioinformatics to Clinical Research Informatics, including web development, database architecture and administration, systems biology, systems analysis and clinical research data integration to support the basic and clinical research enterprise at this prestigious institution. The qualified candidate will also oversee informatics projects. Applicants should possess an M.D. or Ph.D. in Informatics, Computer Sciences, or related field, with a proven track record in informatics operations and research and with experience in administration preferred. |
California | Will Relocate |
Interested Parties Please Contact:
Executive Search & Placement (ES&P Search)
Phone: 818-707-7118
For confidential consideration please submit resumes to Sonia Varian: espsonia@pacbell.net
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MCOL positioning you for a new kind of healthcare |
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| E Mail: mcare@mcol.com | Phone: 209.577.4888 | Fax: 209.577.3557 |
| Write: MCOL 1101 Standiford Ave., Suite C-3, Modesto, CA 95350 | ||
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