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<title>Health Career Professionals</title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp</link>
<description>Health Career Professionals is where the managed care industry goes to search, select, and retain high impact health care professionals.
</description>
<lastBuildDate>Thu, 18 Aug 2011 12:26:06 EST</lastBuildDate>
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<item>
<title>Director, Member and Provider Services </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=141970</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=141970</guid>
<pubDate>Fri, 14 Jan 2011 16:12:17 EST</pubDate>
<description><![CDATA[Director Member and Provider Services - Ft Lauderdale FL  
Continued successful expansion for this health plan has created the need for an expert in driving the activities of the Member and Provider Services department.  You get the chance to assist in the formulation and development of strategies and oversee the implementation of all major operational projects.    
Responsibilities (include): - Establish the strategic Member and Provider vision and objectives.   - Develop and implement performance standards for Member and Provider Services and audit outcomes.  - Develop departmental annual budgets and operate departments within the approved budget. - Work with key stakeholders to develop and implement training materials.   - Maintain compliance with HIPAA guidelines.   
Knowledge/Experience Required: Previous experience in managed care/health plan operational expertise required - projects HR training setting operational objectives. Bachelors' degree in related field 5-7 years of experience in Medicare Medicaid managed care or insurance environment. Management experience required.   
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  You''ll enjoy a comprehensive benefits program very competitive salary   
OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties. ]]></description>
</item>
<item>
<title>Case Manager / RN</title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=158340</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=158340</guid>
<pubDate>Mon, 27 Jun 2011 18:01:33 EST</pubDate>
<description><![CDATA[Since 1976 our client has been serving their community with a wide range of on-campus specialties, a strong community health program, and high quality care.  Their 500+ employees are fully integrated into their community, one of Atlanta Metro's fastest growing areas.  Although small compared to Atlanta hospitals, they are one of the south's highest rated hospitals.  Since becoming  partnered with a large health care system, our client has not lost their hometown appeal.  Now an opportunity exists for a professional nurse case manager to join their team.  In addition to BlueCross BlueShield benefits, generous PTO, and a matching 401(k) plan, this organization highly values their employees with perks such as flexible hours, spending accounts, and free parking.  They know that patients judge them by the people who provide their care.  That's why they go to great lengths to only have the best work in their hospital.  You'll be surrounded by competent, motivated professionals who aren't afraid to roll up their sleeves and get the job done.  The nurse Case Manager is responsible for all aspects of case management. Unlike large, bureaucratic facilities, Case Managers here are hand- on and on top of all their patient's care.  From patient admissions and transfers to finding outside resources, these Case Managers are in charge.  Efficiency, caring, resourcefulness, and competency is what they are looking for.  There are few facilities where case managers that such a wide scope of responsibility and opportunity to make a substantial impact in their patient's care.  For those who thrive in this fast-paced, action oriented environment it will prepare them for much more intense and complex case management work in the future.  Does the following profile describe you?  - A GA licensed Registered Nurse - At least 2 years of acute care nursing experience - At least 1 year of hospital based case management  If so we'd like to talk to you.  Please contact us as soon as possible. This position is not likely to remain open very long.  Jump in with both feet, roll up your sleeves, and stand out as a case management professional! ]]></description>
</item>
<item>
<title>Ongoing Care Manager (RN ONLY) </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138112</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138112</guid>
<pubDate>Fri, 14 Jan 2011 16:16:29 EST</pubDate>
<description><![CDATA[Earn extra cash for helping those who need your help the most!  Flexible schedule set your own hours mileage reimbursement no long term commitment and no direct patient care!  We need professionals to ongoing care management services for selected health plan members.  There are no patient care responsibilities only assessing the health plan member and assisting in managing their care plan.  Two in home visits required per year with at least monthly telephonic updates.  
This is a contract position and could be done in addition to full time work.  Your caseload would be assigned based on your available time.  The work would be done out of a "home based" office and visits can be scheduled according to your availability.  The members require a home visit every 6 months with monthly telephone contacts.  Care Managers have the freedom to set appointments with assigned members according to the hours they want to work.  You can do as few or as many as you want.  You'll be paid weekly on a per case basis.  While working you'll also learn about managed care operations and assist plan members in getting the care they need.  
This is an ideal position for professionals looking to supplement your current income to work part-time or to have a full time job with unlimited flexibility.    
REQUIREMENTS: Licensed RN  Case management experience (CCM PREFERRED)  In home experience preferred 2 yrs Clinical experience preferred Successfully complete a background check Valid driver's license and reliable transportation Email and printer access  
THE COMPANY: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.   
By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties. ]]></description>
</item>
<item>
<title>Care Advocate RN </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138094</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138094</guid>
<pubDate>Fri, 14 Jan 2011 16:08:06 EST</pubDate>
<description><![CDATA[*THIS OPENING IS FOR VARIOUS LOCATIONS ON THE MAIN (BIG) ISLAND OF HAWAII  
Earn extra cash for helping those who need your help the most!  Flexible schedule set your own hours mileage reimbursement no long term commitment and no direct patient care!  We need professionals to complete in-home functional assessments for health plan members.  There are no patient care responsibilities only assessing the health plan member's ability to complete activities of daily living and medical history.  Each assessment takes one home visit to complete.    
Care Advocates have the freedom to set appointments with assigned members according to the hours they want to work.  You can do as few or as many as you want.  You'll be paid weekly on a per completed assessment basis.  While working you'll also learn about managed care operations and assist plan members in getting the care they need.  
This is an ideal position for professionals looking to supplement your current income to work part-time or to have a full time job with unlimited flexibility.  Health insurance benefits are available for qualified professionals.  
REQUIREMENTS: Licensed (Hawaii) RN Email and printer/scanner access Reliable Internet access Comfortable with technology preferred In home experience preferred 2 yrs Clinical experience preferred Successfully complete a background check Valid driver's license and reliable transportation   
THE COMPANY: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
</item>
<item>
<title>Director of Finance </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138096</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138096</guid>
<pubDate>Fri, 14 Jan 2011 16:09:30 EST</pubDate>
<description><![CDATA[Director of Finance - Chicago  
High profile opportunity works very closely with CEO for new business unit. Direct negotiate and handle activities of the finance department and aid the President and CEO in formulating and administering organization financial policies and procedures. Monitor business processes and systems to assure integrity in information and systems.  Oversee preparation of accurate and timely financial reports.  Review communicate and present strategic plans operating budgets and forecasts. Set targets and measures that are appropriate for the site and are directly linked to business unit and corporate objectives. Evaluate program effectiveness and ensure reporting accuracy.  Provide financial plan for performance variances operating alternatives program and investment initiatives etc.  Interpret financial reports for management team.  Serve as contact for the State corporate and business unit functions regarding financial matters.  Actively monitor legislative and political developments affecting the business unit from a financial perspective. Coordinate political contribution activity interact with lobbyists attend political fundraisers and ensure compliance with political contribution statutes.     Knowledge/Experience:  B.S. degree in accounting finance or equivalent. MBA CPA CMA preferred. 5-7 years of experience in accounting and financial analysis. Experience in public accounting operations financial analysis and information systems preferred.  Must have exp in a healthcare or managed care environment.    
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  You''ll enjoy a comprehensive benefits program very competitive salary   
OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
</item>
<item>
<title>VP of Compliance </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138109</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138109</guid>
<pubDate>Fri, 14 Jan 2011 16:18:20 EST</pubDate>
<description><![CDATA[VP of Compliance - Chicago  
Unique opportunity to be part of a team that builds a NEW business unit.  Working closing with the business unit CEO this individual will ensure regulatory compliance with state Medicare Medicaid program and state health care cost containment activities for the state health plan.  Develop and maintain records of Medicare and Medicaid contracts contract amendments compliance measures and improvements policy procedure and process documentation.  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. Oversee the Billing Errors Abuse and Fraud program at the health plan level. Serve as the primary local contact for BEAF reports and liaison with the Corporate Special Investigations Unit (SIU).   Balance reporting requirements to multiple constituencies including. Oversee the health plan privacy program.  Chair participate in attend and plan/coordinate staff departmental committee sub-committee community State and other activities meetings and seminars. Serve on Senior Executive and management committees as well as direct special projects or studies.  Investigate areas of non-compliance and initiate corrective action where necessary.    
EXPERTISE REQUIRED  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 Medicare Medicaid and 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.    
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  You''ll enjoy a comprehensive benefits program very competitive salary   
OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
</item>
<item>
<title>VP of Medical Management </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138110</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138110</guid>
<pubDate>Fri, 14 Jan 2011 16:18:48 EST</pubDate>
<description><![CDATA[VP of Medical Management - Chicago  
HIGHLY VISIBLE opportunity working with the CEO of NEW business unit.  You will establish the strategic vision for this plan direct and coordinate the medical management quality improvement and credentialing functions for the assigned health plan.   
Knowledge/Experience:  Equivalent to a four (4) year education in nursing. Advanced education in nursing health care business or public administration preferred. Thorough knowledge of a specialized or technical field such as clinical nursing managed care and healthcare administration. 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 National Committee on Quality Assurance (NCQA) accreditation process and standards   
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  You''ll enjoy a comprehensive benefits program very competitive salary  OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
</item>
<item>
<title>Director of Finance </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=153743</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=153743</guid>
<pubDate>Thu, 12 May 2011 09:16:32 EST</pubDate>
<description><![CDATA[Director of Finance - Chicago  
High profile opportunity works very closely with CEO for new business unit. Direct negotiate and handle activities of the finance department and aid the President and CEO in formulating and administering organization financial policies and procedures. Monitor business processes and systems to assure integrity in information and systems.  Oversee preparation of accurate and timely financial reports.  Review communicate and present strategic plans operating budgets and forecasts. Set targets and measures that are appropriate for the site and are directly linked to business unit and corporate objectives. Evaluate program effectiveness and ensure reporting accuracy.  Provide financial plan for performance variances operating alternatives program and investment initiatives etc.  Interpret financial reports for management team.  Serve as contact for the State corporate and business unit functions regarding financial matters.  Actively monitor legislative and political developments affecting the business unit from a financial perspective. Coordinate political contribution activity interact with lobbyists attend political fundraisers and ensure compliance with political contribution statutes.     Knowledge/Experience:  B.S. degree in accounting finance or equivalent. MBA CPA CMA preferred. 5-7 years of experience in accounting and financial analysis. Experience in public accounting operations financial analysis and information systems preferred.  Must have exp in a healthcare or managed care environment.    
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  You''ll enjoy a comprehensive benefits program very competitive salary   
OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
</item>
<item>
<title>Director of Quality Improvement </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=153744</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=153744</guid>
<pubDate>Sun, 1 May 2011 18:41:26 EST</pubDate>
<description><![CDATA[ Director of Quality (RN) This is the IDEAL time to join this growing organization.  High energy atmosphere with passionate leadership team.  Through quality initiatives and process improvement activities the Director of Quality will be charged with helping this organization produce better member outcomes and more efficient workflows.  Responsibilities include NCQA Accreditation HEDIS performance. Incorporate best practices into operations. Researchreview and implement new technological tools and processes as warranted to improve health outcomes. Effectively manage and lead a team working with internal and external customers.  Candidates must be an RN with a Bachelor''s Degree in Nursing or other health related field. Five plus years of experience in clinical operations or Managed Care. Masters' Degree preferred. Certified Professional in Health Care Quality  (CPHQ) preferred. ]]></description>
</item>
<item>
<title>VP of Compliance </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154428</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154428</guid>
<pubDate>Thu, 12 May 2011 09:20:05 EST</pubDate>
<description><![CDATA[VP of Compliance - Chicago  
Unique opportunity to be part of a team that builds a NEW business unit.  Working closing with the business unit CEO this individual will ensure regulatory compliance with state Medicare Medicaid program and state health care cost containment activities for the state health plan.  Develop and maintain records of Medicare and Medicaid contracts contract amendments compliance measures and improvements policy procedure and process documentation.  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. Oversee the Billing Errors Abuse and Fraud program at the health plan level. Serve as the primary local contact for BEAF reports and liaison with the Corporate Special Investigations Unit (SIU).   Balance reporting requirements to multiple constituencies including. Oversee the health plan privacy program.  Chair participate in attend and plan/coordinate staff departmental committee sub-committee community State and other activities meetings and seminars. Serve on Senior Executive and management committees as well as direct special projects or studies.  Investigate areas of non-compliance and initiate corrective action where necessary.    
EXPERTISE REQUIRED  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 Medicare Medicaid and 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.    
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  You''ll enjoy a comprehensive benefits program very competitive salary   
OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
</item>
<item>
<title>VP of Medical Management </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154430</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154430</guid>
<pubDate>Thu, 12 May 2011 09:20:23 EST</pubDate>
<description><![CDATA[VP of Medical Management - Chicago  
HIGHLY VISIBLE opportunity working with the CEO of NEW business unit.  You will establish the strategic vision for this plan direct and coordinate the medical management quality improvement and credentialing functions for the assigned health plan.   
Knowledge/Experience:  Equivalent to a four (4) year education in nursing. Advanced education in nursing health care business or public administration preferred. Thorough knowledge of a specialized or technical field such as clinical nursing managed care and healthcare administration. 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 National Committee on Quality Assurance (NCQA) accreditation process and standards   
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  You''ll enjoy a comprehensive benefits program very competitive salary  OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
</item>
<item>
<title>Manager, Case Management </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154921</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154921</guid>
<pubDate>Thu, 12 May 2011 10:33:35 EST</pubDate>
<description><![CDATA[MANAGER CASE MANAGEMENT  Unique opportunity to build train and motivate a new team of case managers. Analyze process procedure and stats to develop and drive high quality cost-effective programs. Maintain compliance  with corporate policy and contractual agreements. Develop staff skills and competencies through training and experience. Promote positive communication internally and externally.  
Knowledge/Experience:  Bachelor's degree in nursing or equivalent experience. 3 - 5 years case management experience and recent nursing experience in an acute care setting particularly in medical/surgical pediatrics or obstetrics and management experience. Familiarity with Medicaid managed care practices and policies CHIP and SCHIP.  Current registered nurse in IL and state driver's license and automobile insurance. Case Management Certification (CCM) preferred. ]]></description>
</item>
<item>
<title>Director, Call Center </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=153745</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=153745</guid>
<pubDate>Thu, 12 May 2011 09:17:10 EST</pubDate>
<description><![CDATA[ Director Call Center (Member and Provider Services) This newly-created role is open due to promotion and growth of this business unit. The successful candidate will direct the activities of the Member and Provider Services Call Centers  including development and implementation of organizational service focused policies and procedures.   
Job Responsibilities: Contributes to building a positive team spirit in a service driven environment. Evaluate call center performance and staffing needs as measured through customer satisfaction. Develops subordinates' sales/service approach and skills while encouraging growth.  Ensure compliance with policies and procedures and government regulations.  Assist in the formulation and development of strategies and oversee the implementation of all major operational projects.  Establish the strategic Member and Provider vision and objectives. - Develop and implement performance standards for Member and Provider Services and audit outcomes. - Develop departmental annual budgets and operate departments within the approved budget.- Work with key stakeholders develop and implement training and training materials.   Maintain compliance with HIPAA guidelines.  
Knowledge/Experience Required:    Bachelors' degree in related field 5-7 years of experience in managing large volume call centers. Medicare Medicaid managed care or insurance knowledge helpful.. Ideal candidate will have experience managing a high performing call center service team.  
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  You''ll enjoy a comprehensive benefits program very competitive salary   
OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties. ]]></description>
</item>
<item>
<title>Medical Director </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=130658</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=130658</guid>
<pubDate>Thu, 12 May 2011 09:18:45 EST</pubDate>
<description><![CDATA[Growing health plan is adding an additional Medical Director. Take your years of primary care experience and be a valuable resource to this health plan.  As the Medical Director you will assist the Vice President of Medical Affairs to direct and coordinate the medical management quality improvement and credentialing functions for the business unit. Your pragmatic perspective and diagnostic inquisitiveness will prove to be foundational to your success in this role. Most importantly as the Medical Director your decisive rendering of judgments will project the image of being a reasonable but firm negotiator.  
Further education in the areas of Health Administration Health Financing Insurance and/or Personal Management will set you apart as a leader among potential Medical Directors.  This education and a commanding leadership ability will enable you to carry out the following responsibilities with ease conviction and excellence:  
- Provides medical leadership of all for utilization management cost containment and medical quality improvement activities.   - Performs medical review activities pertaining to utilization review quality assurance and medical review of complex controversial or experimental medical services.   - Supports effective implementation of performance improvement initiatives for capitated providers.   - Assists VPMA in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.   - Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory state corporate and accreditation requirements.  	 - Assists the VPMA in the functioning of the physician committees including committee structure processes and membership.   - Oversees the activities of physician advisors.   - Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. - Participates in provider network development and new market expansion as appropriate.    - Assists in the development and implementation of physician education with respect to clinical issues and policies.  - Identifies utilization review studies and evaluates adverse trends in utilization of medical services unusual provider practice patterns and adequacy of benefit/payment components.   - Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.   - Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.   - Reviews claims involving complex controversial or unusual or new services in order to determine medical necessity and appropriate payment.  - Develops alliances with the provider community through the development and implementation of the medical management programs.    - As needed may represent the business unit before various publics both locally and nationally on medical philosophy policies and related issues.   - Represents the business unit at  appropriate state committees and other ad hoc committees  
If you are serious about advancing your career and challenging yourself with a culturally diverse population that needs your personal expertise and leadership respond to this posting for more information. This is your chance to make a difference and put your intelligent compassion to work!  
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  You''ll enjoy a comprehensive benefits program very competitive salary   
OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.   
]]></description>
</item>
<item>
<title>Director, Care Management Programs</title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=160926</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=160926</guid>
<pubDate>Thu, 18 Aug 2011 11:23:51 EST</pubDate>
<description><![CDATA[Newly created role DUE TO GROWTH !   Known as one of the best health care places  to work in the Boston metro area, out client is growing faster than expected.  This expansion means opportunity for you!  What is need now is your case management, UR, strategic leadership skills.   With plans to implement PCMH initiatives, their excellent relationship with Mass Health gives this Director a hands on contribution to quality and member's health.  Working closely with the VP of Medical Management, the Director will guide a growing staff and mentor their managers.   Additionally , the Director will be involved in:  - tactical implementation and oversight of medical management activities - utilization management, case management and related programs - statistical analysis of utilization data on programs - budgeting and forecasting for strategic planning - NCQA, State, and/or other accreditation of the Plan  Career-minded managed care professionals will find this to be challenging and rewarding.  Our client is looking for an RN with a Bachelor's degree in nursing or related field.  Masters degree RNs are preferred.   More importantly, the job is designed for an experienced Director level care management nurse who can get results.    ABOUT OUR CLIENT Our client is one of America's premiere managed medicaid companies.  You'll enjoy a comprehensive benefits program, very competitive salary, and the resources of an industry leader.    ABOUT OUR FIRM We are  a managed care executive search company.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract, interim, and permanent positions.  By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
</item>
<item>
<title>Director, Care Management Programs</title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=160927</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=160927</guid>
<pubDate>Thu, 18 Aug 2011 11:24:05 EST</pubDate>
<description><![CDATA[Newly created role DUE TO GROWTH !   Known as one of the best health care places  to work in the Boston metro area, out client is growing faster than expected.  This expansion means opportunity for you!  What is need now is your case management, UR, strategic leadership skills.   With plans to implement PCMH initiatives, their excellent relationship with Mass Health gives this Director a hands on contribution to quality and member's health.  Working closely with the VP of Medical Management, the Director will guide a growing staff and mentor their managers.   Additionally , the Director will be involved in:  - tactical implementation and oversight of medical management activities - utilization management, case management and related programs - statistical analysis of utilization data on programs - budgeting and forecasting for strategic planning - NCQA, State, and/or other accreditation of the Plan  Career-minded managed care professionals will find this to be challenging and rewarding.  Our client is looking for an RN with a Bachelor's degree in nursing or related field.  Masters degree RNs are preferred.   More importantly, the job is designed for an experienced Director level care management nurse who can get results.    ABOUT OUR CLIENT Our client is one of America's premiere managed medicaid companies.  You'll enjoy a comprehensive benefits program, very competitive salary, and the resources of an industry leader.    ABOUT OUR FIRM We are  a managed care executive search company.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract, interim, and permanent positions.  By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
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<title>Sr. Health Economics Analyst (Finance) </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154426</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154426</guid>
<pubDate>Thu, 12 May 2011 09:19:42 EST</pubDate>
<description><![CDATA[As the Sr. Health Economics Analyst (Finance) you will be working with Health Plan and Corporate customers identifying and prioritizing based on business value the recurring and ad hoc data information and analysis needs of the Health Plan to enable them to manage their medical costs and ensure delivery of quality healthcare to their members.   
Responsibilities (include): ~ Coordinate analysis and development initiatives with cross plan initiatives and capabilities. Perform analysis and reporting to support the Health Plan and Corporate.  ~ Support the Medical Management department by examining data integrity analyzing outside vendors models and establishing pharmacy profiles of high utiliziers.  ~ Integrate pharmacy and medical data components for products and special programs.  ~ Conduct opportunity analysis on disease management programs and perform health care outcome analyses projects.  ~ Manage the process for changes to Outcomes Analysis Reports and maintain outcome reporting as it related to CQI initiatives.  ~ Manage analyze and report on clinical financial and health care outcomes data using analytical software such as Access or SAS and present findings to internal and external customers.  ~ Manage the development efforts with our technical team liaisons including business requirements gathering and documentation testing delivery and user adoption effectively communicating deliverable expectations to the Health Plan.  ~ Develop and conduct training programs.   
Knowledge/Experience: Bachelor's degree in related field. 4-6 years experience in health sciences research or health data analysis. Knowledge of statistics and application of higher level mathematical models in medical and pharmacy claims data. Basic understanding of health insurance business claims payment procedures strategies and trends in health care government program. Master's degree preferred.  ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  They have operations in 10 states and over 900 million in revenue.  You''ll enjoy a comprehensive benefits program very competitive salary and generous bonuses.    
ABOUT OUR FIRM: Health Career Professionals LLC is a health care executive search and talent management firm who provides professional services to health care professionals and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
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<item>
<title>Sr. Health Economics Analyst (Clinical) </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=139378</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=139378</guid>
<pubDate>Thu, 12 May 2011 09:19:23 EST</pubDate>
<description><![CDATA[Sr. Health Economics Analyst (Clinical)  
Incredible opportunity to directly impact this growing organization''s financial success. Utilize your expertise in data analysis medical management and claims. Coordinate and manage health economics models and health services outcome studies and  conduct opportunity analysis and outcome reporting for disease management programs and pharmacoeconomics data analysis. Coordinate and prioritize data and analysis requests across health plans and corporate customers. Identify and communicate synergies in information and analysis needs among customers. Working with Health Plan and Corporate customers identify and prioritize based on business value the recurring and ad hoc data information and analysis needs of the Health Plan to enable them to manage their medical costs and ensure delivery of quality healthcare to their members.  Coordinate analysis and development initiatives with cross plan initiatives and capabilities. Perform analysis and reporting to support the Health Plan and Corporate.  Support the Medical Management department by examining data integrity analyzing outside vendors models and establishing pharmacy profiles of high utiliziers. Integrate pharmacy and medical data components for products and special programs.  Conduct opportunity analysis on disease management programs and perform health care outcome analyses projects. o Manage the process for changes to Outcomes Analysis Reports and maintain outcome reporting as it related to CQI initiatives. Manage analyze and report on clinical financial and health care outcomes data using analytical software such as Access or SAS and present findings to internal and external customers.  Manage the development efforts with our technical team liaisons including business requirements gathering and documentation testing delivery and user adoption effectively communicating deliverable expectations to the Health Plan.  
Knowledge/Experience: Bachelor''s degree in related field (Master''s degree preferred) 4-6 years experience in health sciences research or health data analysis clinical expertise (RN) could be a good candidate. Knowledge of statistics and application of higher level mathematical models in medical and pharmacy claims data. Basic understanding of health insurance business claims payment procedures strategies and trends in health care government program. Knowledge of medical management required. Must be experienced in Business Objects or Cognos and enterprise wide applications.  Excellent communication skills required.    
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  They have operations in 10 states and over 900 million in revenue.  You''ll enjoy a comprehensive benefits program very competitive salary and generous bonuses.     
ABOUT OUR FIRM: Health Career Professionals LLC is a health care executive search and talent management firm who provides professional services to health care professionals and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
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<title>Director of Compliance and Regulatory Affairs - Medicare </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=141962</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=141962</guid>
<pubDate>Wed, 30 Mar 2011 16:06:10 EST</pubDate>
<description><![CDATA[Director Compliance &amp;amp; Regulatory Affairs-Medicare (EI18237)  
Newly created role will provide compliance oversight with CMS requirements of all types across all plans.  Serve as senior leadership and main contact between CMS and Centene. Acquire information and requirements from CMS translate into business relevant terms and disseminate as needed through the organization. Manage local Medicare Compliance Directors and determine correct staffing levels based on size and needs of market. Provide plans with advice and expertise about Medicare compliance. Conduct internal compliance audits write corrective action plans and work with Compliance Directors to ensure timely completion and compliance with federal state and local regulatory requirements.  Communicate proactively with CMS about program status and courses of action being planned. Oversee responses to all CMS inquiries and audits. Oversee and audit national vendors with regard to compliance. Monitor and manage the Complaint Tracking Module and disseminate relevant information to the plan Compliance Directors. Assists Plans in maintaining relationships with state and local governing bodies with regard to Medicare. Support business development processes in evaluating and ensuring regulatory authority and compliance with new business regulations.  ________________________________________  
Knowledge/Experience:  Bachelor's degree in related field. 5-7 years of compliance and contract experience with Federal Medicare programs including internal and CMS audits. 2+ years of experience with health care regulatory agencies in development of compliance and fraud programs; 2+ years experience with overseeing implementation of contract requirements.  
]]></description>
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<title>Director of Operations - Medicare </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=141963</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=141963</guid>
<pubDate>Thu, 12 May 2011 09:16:51 EST</pubDate>
<description><![CDATA[Director Operations - Medicare  
Oversee and direct operations and complex projects utilizing cross-functional teams to meet strategic objectives for the Medicare Business Unit. Perform duties as senior liaison between the Medicare business unit and Corporate department.  Partner with multiple stakeholders and business unit leadership to establish operational objectives and procedures. Support due diligence and integration for business unit expansions.  Facilitate operational oversight for Medicare business units and identify opportunities for maintaining effective operations. Ensure cost effective programs are developed and maintained throughout the busniess unit.  Identify operational efficiencies and develop "best practice" policies and procedures.  Contribute to the development of new products and markets.  Utilize corporate and industry standard management tools and techniques to effectively oversee projects; negotiate with project stakeholders to identify resources resolve issues and mitigate risks.  Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and business unit objectives. Provide functional and technical expertise across multiple business and technical areas.  ________________________________________  
Knowledge/Experience:  Bachelor''s degree in Business Administration Finance Accountancy or equivalent. 6+ years of experience in Medicare managed care operations with emphasis on finance and information technology preferred. Project management administration or operations in the Healthcare industry preferred. Master's degree preferred.  
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  They have operations in 10 states and over 900 million in revenue.  You''ll enjoy a comprehensive benefits program very competitive salary and generous bonuses.    
ABOUT OUR FIRM: Health Career Professionals LLC is a health care executive search and talent management firm who provides professional services to health care professionals and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
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<title>Mgr, Contracting Standards </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154423</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154423</guid>
<pubDate>Thu, 12 May 2011 09:19:04 EST</pubDate>
<description><![CDATA[MANAGER CONTRACTING STANDARDS Corporate role will support and monitor hospital physician and ancillary networks in accordance with corporate health plan and multiple state guidelines. Draft contracting language to support state mandated language and product requirements revise language deviations received from negotiators or providers and other contract language requests as needed. Create and implement contracting standards and guidelines regarding provider and vendor agreements. Manage the contract review and assessment of language deviations to standard contracts for all health plans to meet organizational objectives related to network stability growth and operations and finance. Facilitate and provide oversight of the contracting review process ensuring compliance with Contract Management system to ensure proper reviews and approvals are being utilized per established contracting standards and guidelines.  Evaluate and monitor contract language deviations impact on business operations of the organization. Ensure contracting documents are in compliance with government agencies.  Develop necessary contracting documents to support new business opportunities. Work with Corporate Legal and external legal counsel as necessary to create and revise contracting documents required by local government agencies for existing and new business opportunities for the organization.  ________________________________________  
Knowledge/Experience Required:  Bachelor's degree in healthcare administration business administration marketing or related field. MBA or MHA preferred. 5+ years of contracting experience preferably in a healthcare and/or managed care environment. Thorough skills and knowledge of provider contracting standards and guidelines impact of contracting language variations on operations and the principles of negotiation. Familiarity with managed care State and/or Federal health care programs (i.e. Medicaid Medicare) and the insurance industry. Project management experience required.  
]]></description>
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<title>Director, New Business Contracting </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154415</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154415</guid>
<pubDate>Thu, 12 May 2011 09:17:29 EST</pubDate>
<description><![CDATA[Director of New Business Contracting  
Exciting opportunity to support the launch of business in new markets. Collaborate with business development and provider community. Develop a strategy to meet network access and unit cost objectives. Identify appropriate resources for success and assemble the appropriate team across all business functions. Complete development of a budget in alignment with corporate network management and financial objectives.  Lead the implementation and development.  Monitor performance and develop &amp;amp; implement business solutions to address process and/or quality gaps. Complete negotiations with complex and major provider contracts as needed to support network objectives.    
REQUIREMENTS: Bachelor's degree in Healthcare Administration Business Administration or related field 7-9 years of related contracting experience. Experience establishing new markets including the development of the strategy and oversight of the implementation. Strong communication skills dealing with multiple levels within the organization and with the provider community.  MUST BE WILLING TO TRAVEL 4-5 days/week.....can live anywhere but most travel will be western U.S.  
]]></description>
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<title>Health Economics Analyst </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154417</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154417</guid>
<pubDate>Thu, 12 May 2011 09:17:48 EST</pubDate>
<description><![CDATA[Health Economics Analyst - ST. LOUIS  
Develop and support financial modeling tools and regulation reports corporate-wide and specific to the health plans and specialty companies.   
Provide analytics to corporate finance for monthly close. Actively participate in the analysis of reports to improve the performance of multiple business lines.  Perform financial lag call analysis and support.  Perform contract analysis including contract model tool development.  Produce regulational and ad hoc reports.  Collect data requirements from internal and external analytic customers.   
Knowledge/Experience: Bachelor's Degree in Business Finance or equivalent experience and 1 yr of data mining and analysis experience.   
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  They have operations in 10 states and over 900 million in revenue.  You''ll enjoy a comprehensive benefits program very competitive salary and generous bonuses.    
ABOUT OUR FIRM: Health Career Professionals LLC is a health care executive search and talent management firm who provides professional services to health care professionals and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.  
]]></description>
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<title>VP Contracting/Network Development </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138108</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138108</guid>
<pubDate>Fri, 14 Jan 2011 16:17:52 EST</pubDate>
<description><![CDATA[SUMMARY: Executives who want to add immediate value build an organization from the ground floor up and create a department in your own image need to take notice of this opportunity.  Our client a well-established national managed care health plan is establishing a new operation in Mississippi. We are seeking a forward-thinking professional to establish the department''s strategic vision and drive the development of the provider network for the state.  The person who is selected for this role will coordinate negotiate and handle activities of the contracting department and formulate and administer health plan policies and procedures. This is a Vice President level position that also offers executive level base compensation a 25% bonus potential comprehensive benefits and relocation assistance.  Executives who can create an immediate impact will enjoy tremendous corporate exposure and opportunities to move up within the company to COO or corporate roles.  Persons applying to this position can be assured of total confidentiality and discretion.  
As the Vice President you will manage the work flow of the department and communicate standards oversee the training of staff regarding policies and procedures respond to staff's inquiries and resolve complex issues and develop implement and maintain production and quality standards for the department.   
ADDITIONAL RESPONSIBILITIES INCLUDE: - 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.  - Evaluate current procedures and practices for accomplishing the organization and department's objectives to develop and implement improved procedures and practices and to ensure compliance with all related laws regulations and executive orders. - Plan direct and implement through subordinate management and staff department activities.  - Review and analyze reports records and directives and confer with staff to obtain data required for planning work function activities such as new projects status of work in progress and problems encountered.  - Prepare and analyze reports and records on departmental and organizational activities and recommend improvements for management.  - Monitor and analyze costs and prepare departmental budget using computer.   This is a substantial opportunity for a Provider Relations or Contracting executive to step out of the shadows of a large corporate bureaucracy and into the light of a fast moving start-up environment.    
REQUIREMENTS:  - 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.  - Experience in managed care State and/or Federal health programs and project management.  
THE COMPANY: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.  
]]></description>
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<title>VP Contracting/Network Development </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=122714</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=122714</guid>
<pubDate>Wed, 23 Mar 2011 10:33:23 EST</pubDate>
<description><![CDATA[DESCRIPTION: Executives who want to add immediate value build an organization from the ground floor up and create a department in your own image need to take notice of this opportunity.  Our client a well-established national managed care health plan is establishing an new operation in Mississippi. We are seeking a forward-thinking professional to establish the department''s strategic vision and drive the development of the provider network for the state.  The person who is selected for this role will coordinate negotiate and handle activities of the contracting department and formulate and administer health plan policies and procedures. This is a Vice President level position that also offers executive level base compensation a 25% bonus potential comprehensive benefits and relocation assistance.  Executives who can create an immediate impact will enjoy tremendous corporate exposure and opportunities to move up within the company to COO or corporate roles.  Persons applying to this position can be assured of total confidentiality and discretion.  
SUMMARY: Executives who want to add immediate value build an organization from the ground floor up and create a department in your own image need to take notice of this opportunity.  Our client a well-established national managed care health plan is establishing a new operation in Mississippi. We are seeking a forward-thinking professional to establish the department''s strategic vision and drive the development of the provider network for the state.  The person who is selected for this role will coordinate negotiate and handle activities of the contracting department and formulate and administer health plan policies and procedures. This is a Vice President level position that also offers executive level base compensation a 25% bonus potential comprehensive benefits and relocation assistance.  Executives who can create an immediate impact will enjoy tremendous corporate exposure and opportunities to move up within the company to COO or corporate roles.  Persons applying to this position can be assured of total confidentiality and discretion.  
As the Vice President you will manage the work flow of the department and communicate standards oversee the training of staff regarding policies and procedures respond to staff's inquiries and resolve complex issues and develop implement and maintain production and quality standards for the department.   
ADDITIONAL RESPONSIBILITIES INCLUDE: - 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.  - Evaluate current procedures and practices for accomplishing the organization and department's objectives to develop and implement improved procedures and practices and to ensure compliance with all related laws regulations and executive orders. - Plan direct and implement through subordinate management and staff department activities.  - Review and analyze reports records and directives and confer with staff to obtain data required for planning work function activities such as new projects status of work in progress and problems encountered.  - Prepare and analyze reports and records on departmental and organizational activities and recommend improvements for management.  - Monitor and analyze costs and prepare departmental budget using computer.   This is a substantial opportunity for a Provider Relations or Contracting executive to step out of the shadows of a large corporate bureaucracy and into the light of a fast moving start-up environment.    
REQUIREMENTS:  - 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.  - Experience in managed care State and/or Federal health programs and project management.  
THE COMPANY: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
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<title>Health Plan Operations Executive - Vice President </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138100</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138100</guid>
<pubDate>Fri, 14 Jan 2011 16:13:12 EST</pubDate>
<description><![CDATA[MANAGED MEDICAID EXECUTIVE - UNIQUE CHALLENGE  
Are you skilled in medicaid operations?  Can you demonstrate effective P&amp;amp;L management?  Do you want to build and lead the operations department of a new health plan operation?  If you answered ''yes'' to these questions you must seriously consider this new career challenge.  
As the key operations executive our client will look to you to plan build and lead all aspects of operations in this new organization.  Your extensive years of experience in management administration or operations in the managed care insurance industry will have prepared you to be the key leader in this plan''s operations.  As the operations Vice President you have the ability organize and implement every part of the department.  You''ll be the primary executive to manage P&amp;amp;L set the operations strategic vision create the "best practices" standards for all operations and develop and maintain client and employee programs.  
You should also be prepared to prioritize address and manage these additional responsibilities:  
- Serve as chief liaison between the state and Corporate - identify opportunities for maintaining the most cost efficient operation - due diligence and integration for all acquisitions - Assess organizational strengths and weaknesses to recommend enhanced operating model - Use your Business or Healthcare Administration formal education   
If you are ready to step out take on an exceptionally unique challenge and add an impressive executive position to your experience inventory contact us immediately.   
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  They have operations in 10 states and over 900 million in revenue.  You''ll enjoy a comprehensive benefits program very competitive salary and generous bonuses.  Relocation assistance is available however "local" executives are preferred.   
ABOUT OUR FIRM: Health Career Professionals LLC is a health care executive search and talent management firm who provides professional services to health care professionals and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.         
KEYWORDS: medicaid health plan health insurance executive senior management operations vp vice president insurance claims underwriting ACHE FACHE MBA MHA]]></description>
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<title>VP Operational Services </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154922</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154922</guid>
<pubDate>Thu, 12 May 2011 10:33:54 EST</pubDate>
<description><![CDATA[VP Operational Services -  
Oversees Member Services and Provider Services call centers and Provider Operations to include Provider Data Contract Implementation Claims Support and Credentialing. Responsible for development of strategies and operational plans in support of the health plan.   
~ Assist in the formulation and development of plan and corporate strategies.  ~ Exercise departmental leadership with assigned call center issues and operations.  ~ Oversee implementation of all major projects for call centers and operations.  ~ Develop and implement performance standards for functional areas of department and audit outcomes.  ~ Standardize major processes to ensure compliance with State regulations.  ~ Audit and revise/refine all major processes on a routine basis.  ~ Develop and execute strategies to enhance the success of the call centers and operational services functions in collaboration with department corporate and subsidiary businesses' senior managers.  ~ Monitor and report on achievement of committed action plans to appropriate management.   
Licenses/Certifications    
Knowledge/Experience:  Bachelor''s degree in related field. At least 10 years of experience in a related field. Advanced degree preferred.   
]]></description>
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<title>Manager, Clinical Operations (RN) </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154420</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=154420</guid>
<pubDate>Thu, 12 May 2011 09:18:26 EST</pubDate>
<description><![CDATA[For more than 15 years our client has been serving Medicaid members through specialty health care plans.  Today they operate in over 20 states providing services to more than 20 million Medicaid recipients.  Their progressive and active presence in the Medicaid business gives their employees opportunities for personal and professional growth.  THeir team is highly valued for achieving goals presenting ideas and for impacting the members and community they work with.  
 Employees are highly valued by our client.  Not only does the company provide comprehensive benefits such as Medical Dental Vision company paid disability and 401(k) plans they do much more.  Tuition assistance company paid life insurance EAP transit and parking reimbursements and wellness discounts are among the perks their employees enjoy.  
The Clinical Operations Manager is an important role for our client.  You will be the key leader responsible for clinical and non-clinical staff.  Your day will be focused on managing quality initiatives evidence-based practices staff development and compliance.  The manager doesn''t just sit behind a desk! The manager is also involved with local health care organizations through outreach and business development activities.  
We are looking for well educated nurses with multiple years of management experience.  Professionals with experience in managed care coordination or disease management will receive top priority.  Also helpful is a good working knowledge of Oregon''s health care community and resources.  
Apply today!  This opportunity will not last very long!  
OUR FIRM Health Career Professionals a managed care executive search firm offers a complete solution for the professional seeking a career transition.  We offer permanent temporary and contract positions in addition to premier job search coaching and tools.        
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties. ]]></description>
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<title>Director of Quality Improvement </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138098</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138098</guid>
<pubDate>Fri, 14 Jan 2011 16:11:21 EST</pubDate>
<description><![CDATA[Your rich clinical background combined with your managed care experience set you apart from the rest.  As the Director of Quality Improvement you will report directly to the CEO as you lead and direct process improvement activities that provide more efficient and streamlined workflow across the company''s programs nationwide.  
~ Research and incorporate best practices into operations.   ~ Organize and control activities methods and procedures to achieve business objectives.   ~ Formulate and establish policies operating procedures and goals in compliance with internal and external guidelines.  ~ Review and implement new technological tools and processes and fosters team concept with internal and external constituencies.   ~ Present results of improvement efforts and ongoing performance measures to senior management.   ~ Responsible for National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare effectiveness Data and Information Set (HEDIS) performance.  ~ Ensure compliance with State requirements and with accreditation standards (URAC NCQA) as reasonable to meet state requirements in all areas of organizational functioning.   ~ Meet with staff at various levels of the organization to coordinate QI activities and data reporting in order to consolidate this information into high-level program documents (i.e. Statewide quality data reports).   
Knowledge/Experience:  Requires am RN with a  Bachelors degree in Nursing or other LCSW or  clinical degree. Five+ years of quality improvement experience in healthcare operations. Master's Degree preferred. CPHQ is a plus.  
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  You''ll enjoy a comprehensive benefits program very competitive salary   
OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties. ]]></description>
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<item>
<title>VP of Medical Management/RN </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=122727</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=122727</guid>
<pubDate>Wed, 23 Mar 2011 10:32:52 EST</pubDate>
<description><![CDATA[NURSE EXECUTIVE: CAN YOU GROW A TEAM AND DELIVER RESULTS?      Our client offers a tremendous opportunity to grow and develop your own team for an expanding health plan. The Vice President will direct and coordinate the medical management quality improvement and credentialing functions for the  plan based on and in support of the company's strategic plan; establishing the strategic vision and attendant policies and procedures.   
This opportunity will challenge your clinical management and leadership skills.  As you lead this team you must be ready to deliver:    
- Effective and efficient department operations  - The formulated policies to administer your organization  - Insightful analyses of activities costs operations and forecast data to determine department progress toward stated goals and objectives - Impacting executive level contributions to special studies.  - Compliance with National Committee on Quality Assurance (NCQA) and/or Joint Commission on Accreditation of Healthcare Organization (JACHO) standards as determined for accreditation of the health plan.  - Forward thinking ideas in the areas of provider education and contracting as necessary.   
How can you be considered as a contender for this key position?  
- Are you an executive level RN with demonstrated experience AND results in all aspects of managed care case management utilization management quality improvement claims etc....?  
- Have you continued to learn and advance your nursing and management education?  
- Do you have a comprehensive knowledge base of clinical nursing managed care and health care administration?  
- Are you familiar with medical information systems medical claims payments processes and coding?  
- Have you taken an organization through the NCQA process?  
If you can answer ''yes'' to these questions then our client wants to speak with you right away!  Call us today or email your CV or resume for immediate consideration.  This is a career building position with a national managed care company and we expect the competition to be tight.  Let us hear from you now!   ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  They have operations in 10 states and over 900 million in revenue.  You''ll enjoy a comprehensive benefits program very competitive salary and generous bonuses.   
ABOUT OUR FIRM: Health Career Professionals LLC is a health care executive search and talent management firm who provides professional services to health care professionals and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties. ]]></description>
</item>
<item>
<title>Manager or Director  of Compliance </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=124040</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=124040</guid>
<pubDate>Sun, 1 May 2011 18:43:01 EST</pubDate>
<description><![CDATA[As the Manager of Compliance for a major Managed Care Organization you will manage the compliance department functions at corporate office including  periodic monitoring and auditing activities in assigned markets based on established compliance program policies and practices to confirm compliance with federal state and local regulatory contractual and legal requirements.  
You will successfully manage the review and submission of timely and accurate report deliverables and approval in this high priority role.  
Responsibilities include: - Conduct periodic monitoring and auditing activities including those initiated to confirm compliance with new and existing contract requirements for assigned markets. - Oversee the review and response to referral requests in assigned markets.	 - Develop and implement  timely implementation and reporting of corrective action plans in response to identified non-compliance.Represent the Compliance Department at customer meetings for assigned markets.	 - Coordinate drafting of revisions such as rate adjustments to existing contracts for assigned markets.	 - Coordinate review and submission of documentation required to meet ongoing requirements from the corporate oversight of delegated vendors (ODV) project for assigned markets.  - Coordinate collection of information for new and existing licensure filing requirements in assigned markets. - Participate in new business implementations including the identification and tracking of required contract report deliverables as well as new reporting and provider/member materials. - Develop produce and conduct compliance training materials for assigned markets  
Qualifications:   Bachelor's degree in related field  4-6 years of compliance and/or related experience required.  Managed health and/or behavioral health experience preferred.    
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  They have operations in 10 states and over 900 million in revenue.  You''ll enjoy a comprehensive benefits program very competitive salary and generous bonuses.   
OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
</item>
<item>
<title>VP of Medical Management/RN </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104704</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104704</guid>
<pubDate>Thu, 12 May 2011 09:20:42 EST</pubDate>
<description><![CDATA[NURSE EXECUTIVE: CAN YOU GROW A TEAM AND DELIVER RESULTS?      Our client offers a tremendous opportunity to grow and develop your own team for an expanding health plan. The Vice President will direct and coordinate the medical management quality improvement and credentialing functions for the  plan based on and in support of the company's strategic plan; establishing the strategic vision and attendant policies and procedures.   
This opportunity will challenge your clinical management and leadership skills.  As you lead this team you must be ready to deliver:    
- Effective and efficient department operations  - The formulated policies to administer your organization  - Insightful analyses of activities costs operations and forecast data to determine department progress toward stated goals and objectives - Impacting executive level contributions to special studies.  - Compliance with National Committee on Quality Assurance (NCQA) and/or Joint Commission on Accreditation of Healthcare Organization (JACHO) standards as determined for accreditation of the health plan.  - Forward thinking ideas in the areas of provider education and contracting as necessary.   
How can you be considered as a contender for this key position?  
- Are you an executive level RN with demonstrated experience AND results in all aspects of managed care case management utilization management quality improvement claims etc....?  
- Have you continued to learn and advance your nursing and management education?  
- Do you have a comprehensive knowledge base of clinical nursing managed care and health care administration?  
- Are you familiar with medical information systems medical claims payments processes and coding?  
- Have you taken an organization through the NCQA process?  
If you can answer ''yes'' to these questions then our client wants to speak with you right away!  Call us today or email your CV or resume for immediate consideration.  This is a career building position with a national managed care company and we expect the competition to be tight.  Let us hear from you now!   ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  They have operations in 10 states and over 900 million in revenue.  You''ll enjoy a comprehensive benefits program very competitive salary and generous bonuses.   
ABOUT OUR FIRM: Health Career Professionals LLC is a health care executive search and talent management firm who provides professional services to health care professionals and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties. ]]></description>
</item>
<item>
<title>Manager, Provider Relations </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138104</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138104</guid>
<pubDate>Fri, 14 Jan 2011 16:15:04 EST</pubDate>
<description><![CDATA[Manager Provider Relations and Network Development   Do you enjoy partnering with the provider community ? This is a unique opportunity to 	 build and maintain provider networks that promote quality customer outcomes.  Develop and implement activities for the recruitment contracting and retention of effective providers to promote evidence-based practices.  Partner with providers to track outcomes for members receiving treatment.   Work closely with provider to develop best practices.  Responsible for a team of 5 provider specialists.  The manager and the specialists will all travel frequently (in state).  Manager est. at 75% travel.    Knowledge/Experience:    Bachelor's degree or equivalent experience in behavioral health or related field master's degree preferred.  3-5 years network development provider relations or training experience.  Claims and reimbursement system experience and provider business operations knowledge.  In-depth knowledge of state compliance and regulatory processes/laws.  Behavioral health experience in the public sector and supervisory experience preferred.  Working knowledge of managed care industry behavioral health evidence-based practices clinical modalities behavioral health diagnoses and levels of care preferred.   
Licenses/Certifications:  Licensed LCSW LMFT LPC or RN with behavioral health experience a plu - but similar experience would also qualify.  Current state driver's license.  
ABOUT THE COMPANY: Our client is one of America''s premiere managed medicaid companies.  You''ll enjoy a comprehensive benefits program very competitive salary   
OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting company who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services clinical and operational professionals in contract interim and permanent positions.  
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.]]></description>
</item>
<item>
<title>Manager, Service Coordination/RN </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138105</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138105</guid>
<pubDate>Fri, 14 Jan 2011 16:15:33 EST</pubDate>
<description><![CDATA[Lead the Way and Dust Off Your Boots  
You have the exclusive opportunity to help develop and lay the foundation for our client's new Texas operations.  Your years of Case Management and Utilization Management experience will enable you to enhance our client's ability to oversee portions of the STAR + PLUS program.  This opening allows you to draw on your rich years of clinical experience while tapping into your ability to contribute to an organically emergent team.    
As a Manager of Service Coordination you will be able to roll up your sleeves and dig those heels into the daily activities of the field based service coordination.  Being that this is the conception of the Texas branch you will cultivate and leave an inheritance to the community of integrity clinical competency compassion and diligence.    
If you think you are up to the challenge of leading the way with this Texas endeavor contact us today. This position will not last long as it boasts a competitive salary with the potential for growth.   
OUR CLIENT: We have been retained by Bravo Health a managed care health plan headquartered in Baltimore MD and operating plans in Delaware Maryland New Jersey Pennsylvania Texas and Washington D.C.  Currently serving over 360000 members primarily through Medicare Advantage plans Bravo continues to be one of the fastest growing privately held companies in the U.S.  
OUR FIRM Health Career Professionals a managed care executive search firm offers a complete solution for the professional seeking a career transition.  We offer permanent temporary and contract positions in addition to premier job search coaching and tools.    
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.   
KEYWORDS: nurse social worker BSN LCSW licensed clinician case management case manager care coordination utilization review UR  UM pre-cert Medicaid health plan ]]></description>
</item>
<item>
<title>Manager, Health Services </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138103</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=138103</guid>
<pubDate>Fri, 14 Jan 2011 16:14:37 EST</pubDate>
<description><![CDATA[Want to take your nursing career to the next level?  Your dedication to excellence within the Managed Care Industry is an invaluable asset in your next role.  Your higher education and personal development makes you stand out among your peers. Right now your experience and education combined with a strong leadership skill-set is needed in Texas by a growing Managed Care Company.  
As the Manager of the HS Command Center you will be responsible for managing the day-to-day operations of the Health Services Precertification Call/Fax Center and Utilization Management team in Texas. You will assist and support the Medical Director and Health Services management team.   
Three main areas of responsibilities: 1. Precert call/fax center: The position ensures provider request for authorizations including service inquiries are completed in a timely manner. Manages and monitors the inventory and the distribution of all requests for services. Manages the administrative and clinical functions ensuring that appropriate medical criteria are adhered to.    
2. Service Coordinator monitoring: The position coordinates and monitors Service Coordinators' field activities. Ensures security and safety of our client''s Coordinators in the field using remote monitoring tools.  
3. Utilization Management: The position manages nurses in 3 areas: Precertification Inpatient Concurrent Review and Skilled Nursing Facility Concurrent Review.  
The Manager is also responsible for analyzing and improving processes which drive the operation of various technologies and systems used to support the Health Services organization develop produce and analyze statistical measures to evaluate the performance of Health Services operational performance. Additionally you will implement process improvements to ensure that departmental processes operate in the most efficient manner possible. Finally you serve as the key interface between the Health Services and the IT Department by translating workflows and processes into system interface requirements.   
Your ability to make quick decisions and thrive in a challenging environment will help you shine as you supervise a staff of 15 health care professionals including one supervisor. If you are passionate about this opportunity and growing your career please respond quickly.  
OUR CLIENT We have been engaged by a national managed care health plan headquartered in Tennessee and operating plans in Florida Mississippi Alabama Illinois Delaware New Jersey Pennsylvania Texas and Washington D.C.  Currently serving over 1000000 members our client continues to be one of the fastest growing managed care companies in the U.S.  
OUR FIRM Health Career Professionals a managed care executive search firm offers a complete solution for the professional seeking a career transition.  We offer permanent temporary and contract positions in addition to premier job search coaching and tools.    
*By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.   
KEYWORDS: Registered Nurse RN utilization management utilization reviewSTAR PLUS Medicaid Medicare health plan geriatrics ADB aged blind disabled Interqual pre-cert precert pre cert call center ]]></description>
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