<?xml version="1.0" encoding="iso-8859-1"?>
<rss version="2.0" xmlns:atom="http://www.w3.org/2005/Atom">
<channel>
<atom:link href="http://www.healthcareerprofessionals.com/1/173/jobsfeed.xml" rel="self" type="application/rss+xml" />
<title>Health Career Professionals | Candidate Services</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>Mon, 23 Aug 2010 10:06:05 EST</lastBuildDate>
<language>en-us</language>
<item>
<title>Concurrent Review Case Management </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=115099</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=115099</guid>
<pubDate>Mon, 23 Aug 2010 08:46:48 EST</pubDate>
<description><![CDATA[ONLY FOR RNs WHO WANT SOMETHING DIFFERENT...(SIGN ON BONUS AVAILABLE)   Still working evenings and weekends?  Still on call?  Perhaps it is time to consider another direction for your nursing career.  Concurrent Review Case Managers enjoy a family friendly balanced work schedule and intellectual clinical challenges. Our client has an opportunity that will leverage your strong clinical experience PLUS train you for a new career in case management.  Already have case management experience?  Then you too can join a company that highly values and supports their RNs.  Concurrent Review Case Managers are vital members of our client''s managed care operations. You get to practice your clinical skills and become an expert patients turn to without working in direct patient care.  There are five positions available based in Columbia SC.  When you become part of the team you will receive an excellent starting salary incentive program a premiere corporate benefits package generous TUITION REIMBURSEMENT and a chance to make a difference in the lives of Medicaid members.   What does the Concurrent Review Case Manager do?  Some of the responsibilities include:   - Review all health plan members inpatient admissions  -Work with a team to create ongoing care plans and discharge plans - Monitors all clinical activities - Make recommendations for alternative levels of care - Identify cost-effective protocols and develop guidelines for care. - Some Concurrent Review Case Managers will visit patients in local hospitals.   Who can be considered for this outstanding opportunity? - South Carolina licensed RNs - Several years of Med/Surg. (ICU/CCU worked on the floors NICU ER or charge nurse experience). - Highly prefer 3+ years of case management experience (not a strict requirement) - Highly prefer managed care case management experience (not a strict requirement) - Certified Case Managers (CCM) are encouraged to CALL US today. - Must be able to commute daily to the office in downtown Columbia   If you are ready for a new direction in your career you MUST consider this position.  Please respond ASAP!  These positions will not be open for very long.     ABOUT OUR CLIENT: One of America''s premiere managed care companies.  They operate Medicaid health plans in over ten states and have more than 900 million in revenue.  Their South Carolina health plan is growing and they have excellent opportunities for advancement.  This is a company that appreciates their RNs and treats them very well.  They have offices in both Columbia and Charleston.     OUR FIRM Health Career Professionals 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 registered nurse RN case manager case management managed care case manager managed care job nurse case manager UR nurse UM nurse utilization management utilization review CPUR CPUM CCM certified case manager managed care nurse health plan jobs care coordinator care coordination discharge planning Med/Surg ICU CCU floor nurse NICU ER charge nurse ]]></description>
</item>
<item>
<title>Concurrent Review Case Management </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=115101</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=115101</guid>
<pubDate>Mon, 23 Aug 2010 07:51:52 EST</pubDate>
<description><![CDATA[ONLY FOR RNs WHO WANT SOMETHING DIFFERENT...(SIGN ON BONUS AVAILABLE)  
Still working evenings and weekends?  Still on call?  Perhaps it is time to consider another direction for your nursing career.  Concurrent Review Case Managers enjoy a family friendly balanced work schedule and intellectual clinical challenges. Our client has an opportunity that will leverage your strong clinical experience PLUS train you for a new career in case management.  Already have case management experience?  Then you too can join a company that highly values and supports their RNs.  Concurrent Review Case Managers are vital members of our client''s managed care operations. You get to practice your clinical skills and become an expert patients turn to without working in direct patient care.  There are five positions available based in Columbia SC.  When you become part of the team you will receive an excellent starting salary incentive program a premiere corporate benefits package generous TUITION REIMBURSEMENT and a chance to make a difference in the lives of Medicaid members.  
What does the Concurrent Review Case Manager do?  Some of the responsibilities include:  
- Review all health plan members inpatient admissions  -Work with a team to create ongoing care plans and discharge plans - Monitors all clinical activities - Make recommendations for alternative levels of care - Identify cost-effective protocols and develop guidelines for care. - Some Concurrent Review Case Managers will visit patients in local hospitals.  
Who can be considered for this outstanding opportunity? - South Carolina licensed RNs - Several years of Med/Surg. (ICU/CCU worked on the floors NICU ER or charge nurse experience). - Highly prefer 3+ years of case management experience (not a strict requirement) - Highly prefer managed care case management experience (not a strict requirement) - Certified Case Managers (CCM) are encouraged to CALL US today. - Must be able to commute daily to the office in downtown Columbia  
If you are ready for a new direction in your career you MUST consider this position.  Please respond ASAP!  These positions will not be open for very long.     
KEYWORDS: nurse registered nurse RN case manager case management managed care case manager managed care job nurse case manager UR nurse UM nurse utilization management utilization review CPUR CPUM CCM certified case manager managed care nurse health plan jobs care coordinator care coordination discharge planning Med/Surg ICU CCU floor nurse NICU ER charge nurse ]]></description>
</item>
<item>
<title>Supervisor, Clinical Care </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=106103</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=106103</guid>
<pubDate>Mon, 23 Aug 2010 07:51:52 EST</pubDate>
<description><![CDATA[Job Description:	 Perform duties to supervise the day-to-day operations of the service management functions for the Foster Care program; communicate with departmental and plan administrative staff to facilitate daily operations of the service management functions. Supervision of 8-9 FTE''s  
Position Responsibilities ~ Oversee the workflow and day-to-day operations of the service management and utilization management functions including supervising staff  ~ Ensure compliance with established referral pre-certification and authorization policies procedures and processes by staff.  ~ Ensure compliance with established initial and concurrent review care management referral pre-certification and authorization policies procedures and processes  ~ Ensure compliance with plan's emergency management policies procedures and processes by acting as liaison with other business units.  ~ Facilitate on-going communication between service management staff utilization management staff and contracted providers.  ~ Assist with the implementation of policies and procedures regarding service management and utilization management functions.	 ~ Maintain compliance with federal and state regulations and contractual agreements.	 ~ Supervise first level appeals function.  ~ Provide oversight of telephonic review of inpatient admissions with doctors hospitals and other providers.  ~ Monitor the effectiveness of existing procedures and outreach/intervention efforts. Ensure appropriate medical necessity review at all locations.  ~ Coordinate physician's review for adverse determination. Ensure appropriate knowledge/education and interventions are conducted for members defined to be at risk.  ~ Monitor data to address trends or potential quality improvement opportunities including provider issues service gaps member needs.	 ~ Ensure HIPAA compliance    Knowledge/Experience:    Master's degree in behavioral health field or RN required.  Thorough knowledge of a specialized or technical field such as clinical nursing case and/or utilization management involving knowledge plus the application of basic theory. Experience in psychiatric health care settings including utilization review. Knowledge of utilization review procedures and familiarity with mental health community resources.  3-5 years case and/or utilization management. Supervisory experience preferred.  
OUR FIRM: Health Career Professionals LLC is a health care staffing and recruiting firm who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services of 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. License/Certificates: LCSW LMFT LPC PhD PsyD or RN licensed in applicable state(s) ]]></description>
</item>
<item>
<title>VP of Compliance and Regulatory </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104647</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104647</guid>
<pubDate>Mon, 23 Aug 2010 07:51:24 EST</pubDate>
<description><![CDATA[VP of Compliance -  Atlanta GA  
Opportunity to join an established and growing organization. Ensure regulatory compliance with state Medicare Medicaid program and state health care cost containment activities for the state health plan corporate and its business subsidiaries.  
~ Ensure state health plan and corporation are in compliance with federal and state Medicare and Medicaid regulations insurance regulations regulatory requirements for business entities and state contract requirements. ~ 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 to comply with new state law federal law and state contract requirements. ~ 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). ~ Provide guidance to internal state health plan and corporate departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language.  ~ Balance reporting requirements to multiple constituencies including; corporation regional vice president state health plan president chief operating officers and Corporate regulatory and government affairs staff. ~ 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.  
Knowledge/Experience:    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.   
]]></description>
</item>
<item>
<title>VP of Medical Management </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>Mon, 23 Aug 2010 07:51:24 EST</pubDate>
<description><![CDATA[VP of MEDICAL MANAGEMENT (RN) - TEXAS EXCEPTIONAL growth opportunity for experienced RN.  Join a company that is growing nationwide!  This position will report to the VPMA and oversee and ensure consistent application and implementation of medical management policies and programs for the Health Plan. Act as clinical liaison with corporate function to communicate and implement medical management initiatives. Partner with operational management to identify clinical trends manage risks and ensure compliance with corporate and state medical management protocols and policies and programs.   
Partner with operations leadership to identify clinical trends conduct risk assessment and identify areas for improvements in medical management.  Oversee compliance for medical management with state contract and regulations. Develop implement and evaluate the utilization/case management program.  Develop staffing processes and outcomes in medical management that support operational requirements and corporate goals.  Oversight and outcome reporting for Disease Management Programs.    
Knowledge/Experience:  Bachelor's Degree in nursing or related area. 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. Knowledge in case management practices managed care Medicare and Medicaid programs. Familiarity of National Committee on Quality Assurance (NCQA) accreditation process and standards ]]></description>
</item>
<item>
<title>QI Coordinator </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104749</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104749</guid>
<pubDate>Mon, 23 Aug 2010 07:51:24 EST</pubDate>
<description><![CDATA[QI Coordinator  
Growing health plan needs an addition to their QUALITY team! Analyze develop implement and monitor clinical QI initiatives to achieve healthy outcomes.   Perform duties and functions to comply with quality improvement programs according to state requirements. ~ Support Quality Assurance Performance Improvement work plan/initiatives. ~ Schedule and assist with committee and sub-committee preparation. ~ Assist in investigation and resolution of member quality of care complaints. ~ Audit medical records and monitor performance measures for heath care risk management sentinel events and trends.   
Licenses/Certifications: RN (Registered Nurse)required. CPHQ (Certified Professional in Healthcare Quality) preferred.   
Knowledge/Experience: Bachelor's degree in nursing preferred. At least two years clinical nursing experience. At least one year experience in quality function in a healthcare setting. Must have some experience in managed care.  
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>QI Coordinator </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=109333</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=109333</guid>
<pubDate>Mon, 23 Aug 2010 07:51:23 EST</pubDate>
<description><![CDATA[DESCRIPTION: This national managed medicaid company offers a chance to join to their team impact the the quality of care for the needest people.    Your health care quality expertise will be put to use to analyze develop implement and monitor clinical QI initiatives to achieve healthy outcomes..  Based in Columbia SC you''ll enjoy office hours in  a comfortable modern office setting  a comprehensive corporate benefits plan a competitive salary with bonus and the knowledge that you are impacting the quality of care for thousands of people daily.    
As the QI Coordinator your responsibilities will include but not be limited to the following:   - Perform duties and functions to comply with quality improvement programs according to state requirements.  - Support Quality Assurance Performance Improvement work plan/initiatives.  - Schedule and assist with committee and sub-committee preparation. - Assist in investigation and resolution of member quality of care complaints. Audit medical records and monitor performance measures for heath care risk management sentinel events and trends.     
REQUIREMENTS: - RN (Registered Nurse)   - CPHQ (Certified Professional in Healthcare Quality) preferred.  - Bachelor's degree in nursing preferred.   - At least two years clinical nursing experience.   - At least one year experience in quality function in a healthcare setting.  - MUST have HEDIS and NCQA.    
]]></description>
</item>
<item>
<title>VP Medical Affairs </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=115100</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=115100</guid>
<pubDate>Mon, 23 Aug 2010 07:51:23 EST</pubDate>
<description><![CDATA[VP of Medical Affairs  
Contribute as a key member in driving this organization to the top position in behavioral managed care. Responsible for organization''s clinical vision philosophy and strategy and effectively represent the organization to various public stakeholders both locally and nationally.Oversee overall medical management and quality improvement programs support of the organization's strategic plan.  Oversee and support the medical management structure assuring high quality care and compliance with regulatory and accreditation requirements. Administrative oversight and accountability for the quality improvement department.   
Recruit coordinate and oversee activities of assistant medical directors and physician advisors. Recruit and utilize the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participate in provider network development and new market expansion as appropriate.   
Responsible for business unit physician committees including committee structure processes and membership.  Review and participate in the clinical response to RFP's as requested.   
EXPERIENCE REQUIRED: Requires an unrestricted licensed Medical Doctor or Doctor of Osteopathy board certification in Psychiatry required. Previous experience as a senior level medical position with a managed behavioral health organization is required. Prior experience as a Medical Director for an MBHO with Medicaid/Medicare programs is preferred. Experience treating or managing care for a culturally diverse population preferred. Experience with quality improvement for an organization as well as knowledge of certification/accreditation standards such as URAC NCQA is preferred. Course work in the areas of Health Administration Health Financing Insurance and/or Personnel Management is a plus.      
]]></description>
</item>
<item>
<title>Director of Contracting &amp; Provider Relations </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=46754</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=46754</guid>
<pubDate>Mon, 23 Aug 2010 07:51:23 EST</pubDate>
<description><![CDATA[Director of Contracting and Provider Relations    JOB DESCRIPTION: Perform duties to coordinate negotiate and handle activities of the provider contracting and relations/services function for the designated health plan and aid the Plan President and Corporate    SUMMARY: Perform duties to coordinate negotiate and handle activities of the provider contracting and relations/services function for the designated health plan and aid the Plan President and Corporate in formulating and administering organizational policies and procedures. Includes negotiating large hospital physician (IPAs PPMs multi-specialty groups) and ancillary service agreements and overseeing external customer service for providers in accordance with Corporate health plan and government regulations and guidelines.    Stewardship and Fiduciary Responsibilities: Monitor provider contracting and relations activities to determine their efficiency and assure integrity in records information and in systems in compliance with Company policies and standards government laws and regulations. Negotiate contracts with interested providers utilizing model provider agreements and follow up on contracts as appropriate. Lead assigned negotiations (i.e. hospital physician and ancillary) and ensure that the negotiations result in the unit cost targets expected and meet the objectives of the Company and approximate the State's reimbursement to the provider. Ensure compliance with national contracting standards including for example the baseline assessment of risk contracts (e.g. Model 1 Model 1 Lite etc.) reimbursement standards provider set-up rules exception process and use of model contract language.    Planning: Develop and implement a network development plan for the assigned region and set of providers and identify and initiate contact with potential providers in support of the Company's strategic goals and objectives. Effectively integrate new programs and strategies to reach per member per month targets and provide oversight to the provider set-up and contract configuration in the computer system to ensure accurate claims adjudication. Participate in multi-disciplinary team activities to address unit cost drivers. Perform basic financial analyses to identify medical cost improvement opportunities develop strategies to reach financial goals and execute contracting strategies to meet goals and objectives. Plan for continuous upgrading of staff skills.    Budget/Financial Management: Effectively manage budget and all resources to balance both short and long-term needs.    Project Management: Effectively and creatively manage projects.  Reporting: Prepare and analyze reports and records on provider contracting and servicing departmental and organizational activities and recommend improvements for management using computer. Evaluate and monitor providers' performance standards and financial performance of contracts. Disseminate relevant information for effective decision support by business unit leaders. Monitor and report on achievement of committed action plans to appropriate management.  People Management: Create effective organizational structure roles and jobs. Develop staff skills and competencies through training and experience. Select or hire individuals wisely into new roles. Coach and mentor. Lead by example to create desired culture and motivated people in organization. Assure appropriate management and skills development for self and staff.     ]]></description>
</item>
<item>
<title>Case Manager I / RN - Prior Authorization </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=56613</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=56613</guid>
<pubDate>Mon, 23 Aug 2010 07:51:23 EST</pubDate>
<description><![CDATA[CASE MANAGEMENT CAREER OPENS A NEW DOOR   One of America''s premiere managed care companies has created a door-opening career opportunity.  Rarely does an opportunity like this come along.  For a limited time our client has the capacity to leverage your strong clinical experience and train you for a new career in case management and prior authorization.  This is a chance to join a major corporation yet still impact the daily care of the neediest people.    You''ll get to learn managed care operations practice your clinical skills and become an expert patients turn to without working in direct patient care.  Based in Columbia SC you''ll enjoy office hours in a comfortable modern office setting a comprehensive corporate benefits plan a competitive salary with bonus and the knowledge that you are impacting the quality of care for thousands of people daily.  If you desire a growing career direction as a Case Manager/Prior Authorization RN and not just another job check this out:    1) You''ll draw upon your clinical experience to review requests for prior authorization for radiology services (MRI's CAT Scans etc.)  2) The referral staff will rely upon your RN knowledge to make the appropriate referrals. 3) Patients and providers alike will look to you for education and training about the programs you are involved with. 4) If you''ve gain Utilization Management certification you will use your certification knowledge every day in this role.  5) Our client is looking for leaders and you''ll have the chance to grow and advance with this national corporation.   Case management is not for every RN.  If you think you are ready to join this team as a valued contributor then we need to hear from you today!     .   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 registered nurse RN case manager case management managed care case manager managed care job nurse case manager UR nurse UM nurse utilization management utilization review CPUR CPUM CCM certified case manager managed care nurse health plan jobs care coordinator care coordination.]]></description>
</item>
<item>
<title>Health Plan Operations Executive - Vice President </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=78346</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=78346</guid>
<pubDate>Mon, 23 Aug 2010 07:51:23 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>
</item>
<item>
<title>Concurrent Review Case Management </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104630</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104630</guid>
<pubDate>Mon, 23 Aug 2010 07:51:23 EST</pubDate>
<description><![CDATA[ONLY FOR RNs WHO WANT SOMETHING DIFFERENT...(SIGN ON BONUS AVAILABLE)  
Still working evenings and weekends?  Still on call?  Perhaps it is time to consider another direction for your nursing career.  Concurrent Review Case Managers enjoy a family friendly balanced work schedule and intellectual clinical challenges. Our client has an opportunity that will leverage your strong clinical experience PLUS train you for a new career in case management.  Already have case management experience?  Then you too can join a company that highly values and supports their RNs.  Concurrent Review Case Managers are vital members of our client''s managed care operations. You get to practice your clinical skills and become an expert patients turn to without working in direct patient care.  There are five positions available based in Columbia SC.  When you become part of the team you will receive an excellent starting salary incentive program a premiere corporate benefits package generous TUITION REIMBURSEMENT and a chance to make a difference in the lives of Medicaid members.  
What does the Concurrent Review Case Manager do?  Some of the responsibilities include:  
- Review all health plan members inpatient admissions  -Work with a team to create ongoing care plans and discharge plans - Monitors all clinical activities - Make recommendations for alternative levels of care - Identify cost-effective protocols and develop guidelines for care. - Some Concurrent Review Case Managers will visit patients in local hospitals.  
Who can be considered for this outstanding opportunity? - South Carolina licensed RNs - Several years of Med/Surg. (ICU/CCU worked on the floors NICU ER or charge nurse experience). - Highly prefer 3+ years of case management experience (not a strict requirement) - Highly prefer managed care case management experience (not a strict requirement) - Certified Case Managers (CCM) are encouraged to CALL US today. - Must be able to commute daily to the office in downtown Columbia  
If you are ready for a new direction in your career you MUST consider this position.  Please respond ASAP!  These positions will not be open for very long.     
KEYWORDS: nurse registered nurse RN case manager case management managed care case manager managed care job nurse case manager UR nurse UM nurse utilization management utilization review CPUR CPUM CCM certified case manager managed care nurse health plan jobs care coordinator care coordination discharge planning Med/Surg ICU CCU floor nurse NICU ER charge nurse ]]></description>
</item>
<item>
<title>VP Contracting/Network Development </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104646</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104646</guid>
<pubDate>Mon, 23 Aug 2010 07:51:23 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>
</item>
<item>
<title>Director, Quality Services</title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=119457</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=119457</guid>
<pubDate>Tue, 17 Aug 2010 09:17:43 EST</pubDate>
<description><![CDATA[Make your own mark in this historical City!  Just blocks away from the waters of the inner harbor, you have the chance be a leader in the Managed Care Industry.  Your investments in higher education and years of experience with HEDIS and NCQA have primed you to be the ideal contender for this opportunity.  As the corporate Director of Quality Services, you will be able to apply your years of clinical service as well as your history with quality improvement to add value to this growing organization.  Your leadership skills will be refined as you lead others onto greatness in the Managed Care Industry.    Along with being an excellent leader, your great communication skills will be a true asset to collaborate with and educate those around you on the principles of quality improvement.  You will be a valued resource as you develop and pen policies to enhance the operational quality of the trade.  Baltimore is vibrant city on the water - always evolving with new hotels, and new and expanding attractions.  If you would like to explore this opportunity, welcoming the challenge of increasing your portfolio and effect on the Managed Care Industry, contact us today. This position will not last long as it boasts a competitive salary, with the potential for growth. Our client is ready to assist with relocation if Baltimore becomes your next career destination!  OUR CLIENT: Our client is a growing a managed care health plan headquartered in Baltimore, with expanding operations in five other states.  Currently serving over 350,000 members, our client continues to be one of the fastest growing, privately held companies in the U.S.  OUR FIRM Our firm is 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, quality improvement, quality assurance QI, QA, HEDIS, NCQA, managed care nurse, utilization review, utilization management, health plan, clinical services, care coordination, hbcs ]]></description>
</item>
<item>
<title>Concurrent Review Case Management </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104629</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=104629</guid>
<pubDate>Mon, 26 Jul 2010 08:46:01 EST</pubDate>
<description><![CDATA[ONLY FOR RNs WHO WANT SOMETHING DIFFERENT...(SIGN ON BONUS AVAILABLE)  
Still working evenings and weekends?  Still on call?  Perhaps it is time to consider another direction for your nursing career.  Concurrent Review Case Managers enjoy a family friendly balanced work schedule and intellectual clinical challenges. Our client has an opportunity that will leverage your strong clinical experience PLUS train you for a new career in case management.  Already have case management experience?  Then you too can join a company that highly values and supports their RNs.  Concurrent Review Case Managers are vital members of our client''s managed care operations. You get to practice your clinical skills and become an expert patients turn to without working in direct patient care.  This position is  based in Mt Pleasant SC.  When you become part of the team you will receive an excellent starting salary incentive program a premiere corporate benefits package generous TUITION REIMBURSEMENT and a chance to make a difference in the lives of Medicaid members.  
What does the Concurrent Review Case Manager do?  Some of the responsibilities include:  
- Review all health plan members inpatient admissions  -Work with a team to create ongoing care plans and discharge plans - Monitors all clinical activities - Make recommendations for alternative levels of care - Identify cost-effective protocols and develop guidelines for care. - Some Concurrent Review Case Managers will visit patients in local hospitals.  
Who can be considered for this outstanding opportunity? - South Carolina licensed RNs - Several years of Med/Surg. (ICU/CCU worked on the floors NICU ER or charge nurse experience). - 3+ years health plan case management work experience - Certified Case Managers (CCM) are encouraged to CALL US today. - Must be able to commute daily to the office in Mt Pleasant  
If you are ready for a new direction in your career you MUST consider this position.  Please respond ASAP!  These positions will not be open for very long.    
ABOUT OUR CLIENT: One of America''s premiere managed care companies.  They operate Medicaid health plans in over ten states and have more than 900 million in revenue.  Their South Carolina health plan is growing and they have excellent opportunities for advancement.  This is a company that appreciates their RNs and treats them very well.  They have offices in both Columbia and Charleston.      
KEYWORDS: nurse registered nurse RN case manager case management managed care case manager managed care job nurse case manager UR nurse UM nurse utilization management utilization review CPUR CPUM CCM certified case manager managed care nurse health plan jobs care coordinator care coordination discharge planning Med/Surg ICU CCU floor nurse NICU ER charge nurse ]]></description>
</item>
<item>
<title>VP of Finance </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=115102</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=115102</guid>
<pubDate>Mon, 26 Jul 2010 08:46:01 EST</pubDate>
<description><![CDATA[VP of Finance - Health Plan - GA location   Provide leadership and oversight of all aspects of finance for growing Business Unit.  Serve as the Chief liaison between Corporate Finance and the Business Unit.   Establish financial strategic vision objectives policies and procedures in support of the overall strategic plan.  Oversee budgets forecasts and monthly business closings.  Analyze financial departmental and organizational activity reports and recommend solutions.  Direct business units Health Economics and reporting.  Oversee and validate pricing models and lead initiatives to identify inefficiencies and areas of development and improvement.   
Knowledge/Experience:  Requires a Bachelor''s degree in Finance Accounting Economics Business Administration or equivalent. At least 5 years of experience in a top finance position in the healthcare or insurance industry - strongly prefer managed care experience. Previous Management experience required. Master's degree preferred.   
]]></description>
</item>
<item>
<title>Director of Contracting - need 2 </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=69662</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=69662</guid>
<pubDate>Fri, 23 Jul 2010 12:52:48 EST</pubDate>
<description><![CDATA[DIRECTOR of CONTRACTING  
Perform duties to coordinate and negotiate hospital physician school and ancillary service agreements that are in accordance with Corporate health plan and State guidelines.   POSITION QUALIFICATION REQUIREMENTS: Knowledge/Experience: Equivalent to a bachelor's degree in a related field master's degree preferred plus 5-7 years related experience including 3 years of management experience; experience in a managed care or insurance environment preferably in Medicaid; knowledge of related field. Thorough skills and knowledge of contracting/sales provider customer service and/or marketing. Knowledge of contracting language and the principles of negotiation. Experience in claims processing marketing/sales medical economics health plan finance and/or customer service experience in a healthcare or insurance environment. Experience in managed care State and/or Federal health programs and project management.    PRINCIPAL FUNCTIONS &amp;amp; ACCOUNTABILITIES: Significant Duties: Develop and implement a network development plan for an assigned region and set of providers and identify and initiate contact with potential providers. Negotiate contracts with interested providers utilizing model provider agreements and follow up on contracts as appropriate. Leads assigned negotiations (i.e. hospital physician and ancillary) and ensure that the negotiations result in the unit cost targets expected and meet the objectives of the Company and approximate the State's reimbursement to the provider. Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication. Evaluate and monitor providers' performance standards and financial performance of contracts. Facilitate the organization of provider focus groups. Ensures compliance with national contracting standards including for example the baseline assessment of risk contracts (e.g. Model 1 Model 1 Lite etc.) reimbursement standards provider set-up rules exception process and use of model contract language. Participates in multi-disciplinary team activities to address unit cost drivers. Implement strategies to reach pmpm targets. Performs basic financial analyses to identify medical cost improvement opportunities and develops and executes contracting action plans to achieve results.   
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 Contracting </title>
<link>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=69663</link>
<guid>http://www.healthcareerprofessionals.com/1/173/job_search_global.asp?JobID=69663</guid>
<pubDate>Fri, 23 Jul 2010 12:52:48 EST</pubDate>
<description><![CDATA[DIRECTOR of CONTRACTING  
 Perform duties to coordinate and negotiate hospital physician school and ancillary service agreements that are in accordance with Corporate health plan and State guidelines.   POSITION QUALIFICATION REQUIREMENTS: Knowledge/Experience: Equivalent to a bachelor's degree in a related field master's degree preferred plus 5-7 years related experience including 3 years of management experience; experience in a managed care or insurance environment preferably in Medicaid; knowledge of related field. Thorough skills and knowledge of contracting/sales provider customer service and/or marketing. Knowledge of contracting language and the principles of negotiation. Experience in claims processing marketing/sales medical economics health plan finance and/or customer service experience in a healthcare or insurance environment. Experience in managed care State and/or Federal health programs and project management.    PRINCIPAL FUNCTIONS &amp;amp; ACCOUNTABILITIES: Significant Duties: Develop and implement a network development plan for an assigned region and set of providers and identify and initiate contact with potential providers. Negotiate contracts with interested providers utilizing model provider agreements and follow up on contracts as appropriate. Leads assigned negotiations (i.e. hospital physician and ancillary) and ensure that the negotiations result in the unit cost targets expected and meet the objectives of the Company and approximate the State's reimbursement to the provider. Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication. Evaluate and monitor providers' performance standards and financial performance of contracts. Facilitate the organization of provider focus groups. Ensures compliance with national contracting standards including for example the baseline assessment of risk contracts (e.g. Model 1 Model 1 Lite etc.) reimbursement standards provider set-up rules exception process and use of model contract language. Participates in multi-disciplinary team activities to address unit cost drivers. Implement strategies to reach pmpm targets. Performs basic financial analyses to identify medical cost improvement opportunities and develops and executes contracting action plans to achieve results.  ]]></description>
</item>
</channel>
</rss>