Healthcare Positions Oct 25, 2014
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Healthcare Positions

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Manager, Utilization Review (RN) (Santa Fe, NM)

Company: Qualis Health

Description:


Every day, Qualis Health helps patients get the right care, in the right setting and at the right time. We provide web-based utilization management and waiver review programs that focus on patient safety and cost containment by using evidence-based protocols to support the delivery of appropriate healthcare.

We're pursuing an opportunity to serve as the Third Party Assessor (TPA) and utilization review organization that evaluates the medical necessity of healthcare services provided to New Mexico Medicaid recipients.

In this key role to be based in (or near) Santa Fe, you would:

* Serve as our local point-of-contact to the Medicaid agency, provider community, recipient representatives, and other in-state stakeholders.
* Develop and maintain policies and procedures, staffing protocols, training and internal quality control programs, and budgets.
* Manage the clinical and support staff assigned to the program.
* Provide subject matter expertise on contractual provisions and relevant regulations, and ensure compliance with all required legal, contractual, accreditation, and compliance standards.

You bring the following qualifications:


* 4 years of clinical nursing experience that includes at least 1 year of experience working in the field of intellectual disability or with other disability populations.
* 5 years of utilization review or other care management experience.
* 4 years of department / program management work experience.
* Experience with Medicaid utilization review and waiver programs highly desirable.
* BA / BS in nursing, healthcare administration, or a related field.
* Current, active, unrestricted New Mexico RN licensure.


Apply at https://qualishealthcareers.silkroad.com/qualisext/EmploymentListings.html 
EEO/AA/M/F/D/V

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Contracting Executive (Reno, Nevada)

Company: Renown Health

Description:

 

"The biggest little city in the world"
More than 300 sunny days each year!

Renown Health, Nevada's largest and only locally owned not-for-profit integrated healthcare network, is seeking a visionary and creative individual to lead negotiations for all of Renown Health's contracting. He/she will serve as the chief negotiator for all managed care contracts for the hospitals, physicians, ancillary services, and the health plan. The successful candidate will be an innovative, driven, forward-thinking, collaborative leader with strong knowledge of network development, provider and payer contracting strategies and proven results in negotiating contracts with hospitals, health plans, physician groups, and ancillary service agreements. 

This opportunity is being presented by Kim Kueser, Senior Consultant, MSA Executive Search. For additional information, or those wishing to share referrals, contact Patricia McCollum, Recruiter, at 
patricia.mccollum@msasearch.com.

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Quality Improvement Manager (Austin, TX)

Company: Sendero Health Plans

Description:


Sendero Health Plans is recruiting to fill the position of Quality Improvement Manager. In this position and under broad general direction, you will develop and implement the Quality Improvement program under the direction of the Health Services Director and Chief Medical Officer. This position works with a wide range of people including physicians, practice site staff, and health plan staff.

To view a complete job description and to apply directly, please go to:
https://home2.eease.adp.com/recruit/?id=9745122 

EEO/Drug and Tobacco free environment.

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Director of Compliance (Austin, TX)

Company: Sendero Health Plans

Description:

 

Sendero Health Plans is recruiting to fill the position of Director of Compliance. In this position you will be responsible for government relations and compliance with state and federal laws and regulations. Key responsibilities include development of a compliance plan to identify and respond to all regulatory requirements from the Texas Health and Human Services Commission (HHSC) and Texas Department of Insurance (TDI) as well as the federal Centers for Medicare and Medicaid (CMS). This position works closely with staff in all functional areas and with affiliated organizations. This position is expected to maintain strong working relationships with HHSC (Health and Human Services Commission) and TDI.

To view a complete job description and to apply directly, please go to:
https://home2.eease.adp.com/recruit/?id=9497332 

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