Career Resources Newsletter    |  March 2010    |   Volume Twelve Issue Three

  3. Wellmont names Bob Burgin interim CEO

  4. Insurance Administrative Solutions Promotes Mark Postove to Senior VP & Director of IT
 
  5. Debi Heck to Lead Health Management Strategies Team at American Specialty Health

  6. Independence Blue Cross names John Janney to newly created position: SVP marketing services

  7. Aetna Medicaid in Texas Announces New CEO

  8. Eric H. Schultz named as new president and CEO of Harvard Pilgrim Health Care Inc.
 
  9. Stacey Fahrner Joins Prime Therapeutics as Vice President, Government Affairs

10. Sterling Health Plans Hires National Medical Director

11. Marcus Thygeson, M.D. Named President of Allina Hospitals’ Center for Health Care Innovation

12. Humana Names Roy Goldman Vice President and Chief Actuary

Chief Applications & Web Architect (Philadelphia, PA)

The Company:
Leading edge healthcare informatics start-up that provides an innovative solution suite for unlocking the value of integrated health data for secondary use in biomedical and health services research, life science product development and commercialization, healthcare quality improvement and public health.

Summary:
The Chief Applications & Web Architect’s role is to build the applications architecture for internal custom applications and web/web services environments. This includes constructing and implementing the technical design for the organization’s presence on the internet; designing, building, and implementing new Web services ; integrating sites with back end applications; migrating legacy applications to the Web; and performing day-to-day administration of the organization’s Web portfolio. Use of a variety of Web development languages as required. Experience in SOA services development methodologies, business intelligence, and rules engines a major plan. Experience in healthcare an absolute must. Position based in Greater Philadelphia.

Position Requirements:

Formal Education & Certification

• College diploma or university degree in the field of computer science and/or 10 years equivalent work experience with reference (a must).

Knowledge & Experience

• Vast experience in gathering and analyzing business requirements in order to meet strategic goals and development efforts.
• In-depth knowledge of Web technologies, protocols, and tools including Visual Studio 2008, Team Foundation Server 2008, MOSS 2007 (in depth knowledge including Feature development, WSPs, SharePoint page processing architecture, Master pages, etc.).
• Strong understanding of Internet programming languages, including .NET 2.0, 3.0 (C# & VB.NET), WCF, ASP.NET, XML, PL/SQL, T-SQL, JavaScript, CSS, and AJAX, Adobe Air.
• Advanced understanding of object-oriented programming languages.
• Hands-on experience with Web-database integration and a range of relational database platforms, including Sql Server and Oracle. Understanding of MPP database architecture (i.e.ParAccel a plus).
• Working knowledge of Web servers and application servers.
• Experience with e-commerce, intranet, and extranet development.
• Project management/project lifecycle/project methodology skills required.
• Experience with computer graphic and multimedia design preferred.
• Good understanding of the organization’s goals and objectives.
• Excellent knowledge of applicable data privacy practices and laws.
• Thorough understanding of application development methodologies.
• Comprehensive experience with structuring, developing, and implementing interactive corporate Web sites.

Please send resumes and current compensation to:

Lee Calhoon | President & CEO
Lee Calhoon & Co.
Tel: 610-469-9000
Fax: 610-469-0398
Email: leecalhoon@aol.com
LinkedIn: http://www.linkedin.com/in/leecalhoon

Visit our website at: www.leecalhoon.com

Chief Medical Officer (CMO), BCBSLA - Baton Rouge, LA

Witt/Kieffer, an executive search firm with over 40 years of experience, has been retained by Blue Cross and Blue Shield of Louisiana (BCBSLA) to conduct an executive recruitment for their Chief Medical Officer (CMO).

As an independent member of Blue Cross and Blue Shield Association, BCBSLA, headquartered in Baton Rouge, Louisiana, covers over one million members, employs 1,700 individuals and has a twelfth straight “A” rating from Standard & Poor’s for their financial strength and other factors.

Reporting to the CEO, the Chief Medical Officer has a senior management leadership role both internally and externally. The CMO will assume a key leadership role as an active and visible participant in the context of customer interaction and initiatives. He/she must be a credible contributor in a wide variety of external activities within the provider and employer community. Internally, the CMO is not only the company’s top clinician but is also the catalyst and leader for change to implement best practices which will create a progressive, innovative and transformed clinical affairs department. Equally as important is the responsibility of building upon and strengthening relationships with the various departments within the organization.

A Medical Doctorate degree with board certification in an approved medical specialty is required; an additional advanced degree in business/healthcare management is preferred. An unrestricted M.D. degree with license or the ability to obtain a license to practice medicine in LA is necessary. The individual must have at least ten years of experience in the Medical Director role with at least five years in managed care; ten years of medical practice experience is required in a relevant specialty area. Superior customer interaction skills as an advisor and a medical visionary are critical.

Nominations, referrals, and expressions of interest (including cover letter and resume) should be submitted confidentially to: BCBSLACMO@wittkieffer.com. Items which cannot be submitted electronically may be sent to Stephen J. Kratz or Shirley Cox Harty, c/o Witt/Kieffer, 3414 Peachtree Road, Suite 352, Atlanta, GA 30326, or faxed to (404) 261-1371. Inquiries may be directed by phone to 404-233-1370.

PLEASE SUBMIT RESUME TO: 
ES&P SEARCH 
espsonia@pacbell.net 
Contact: Sonia Varian 
T 818.707.7118

VICE PRESIDENT OF MEDICAL AFFAIRS - TEXAS
Responsible for the organization’s clinical vision, philosophy and strategy. Oversee the medical management and quality improvement programs support of the organization’s strategic plan. Develop and present clinical vision to various public stakeholders both locally and nationally. 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.
Knowledge/Experience:
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.

V.P. SALES AND BUSINESS DEVELOPMENT - TEXAS
Oversee national Sales and Business Development
Experience with sales and business development activities in Medicaid/Medicare or public sector programs preferred. Master’s degree preferred. Behavioral Health experience is preferred
Requires a Bachelor's degree in Business Administration, Public Health/Administration or equivalent. Experience in healthcare sales/business development or with complex, consultative sales of programs/solutions to government entities.

• Responsible for developing new market initiatives, assessing new markets, analyzing business opportunities and driving sales process to expand the business unit.

• Develop and oversee plan for government relations support as it relates to program strategies and market introductions; manage relationships with government officials to advance the company’s position.

MEDICAL DIRECTOR - HEALTH PLAN - SO. CALIFORNIA
Under the supervision of the Associate Chief of Managed Care, the Medical Director, Managed Care, is responsible for the appropriateness and quality of medical care. The Medical Director shall develop processes for medical reviews for coverage determinations for medical services and participate in the grievance and appeals process. The Medical Director shall provide guidance to health plan quality improvement, utilization management, as well as continuous measuring, monitoring and improvement of the health delivery system for plan members. Participate in strategic planning efforts for the Managed Care Division with respect to medical aspect of the health plan.

• Maintain knowledge in general medicine and disease specific national guidelines.

• DM utilization review and care management programs.

• Assure members receive quality, medically necessary care that balances individual need with cost effectiveness.

MANAGER OF CLAIMS - HEALTH PLAN - SO. CALIFORNIA
Align the daily operations of the Claims Department with the strategic direction of the organization.
Clearly define department goals and focus staff upon these goals.
Build supportive, team-oriented environment for the staff through embodying a sense of empowerment, demonstrating positive thinking and establishing common goals and interdependence with employees.
Manage corrective actions in accordance with Quality Management or Compliance Department instructions, and Federal or State guidelines and expectations.
Review all department operating procedures & policies on at least an annual basis & recommend any necessary revisions or additions as necessary.
Draft operating procedures, policies & procedures for review & approval by appropriate Committees, Management.
Supervises Claims Examiner(s), Senior Claims Examiners, temporary Claims staff & administrative support staff. Carries out supervisory responsibilities in accordance with policies and applicable laws.
Minimum one (1) year experience with supervisory position in a Health Plan claims department.
Proven experience in customer service.
Thorough knowledge of claim procedures, policies, terminology, federal/state statutes & guidelines, including extensive knowledge of Medicare & Medicaid payment methodology.
The ability to operate PC or network based claims software programs, proficiency in Microsoft Word & Excel required.
Experience with EZ-CAP Claims Adjudication software preferred.
Advanced technical proficiency with medical terminology, all standard medical coding guidelines (CPT, HCPCS, ICD-9, ICD-10 when applicable, Medicaid Local Codes, Modifier Codes) & all Medicare & Medicaid Payment Guidelines or general claims payment guidelines & practices including Medicare DRG based Prospective Payment systems (PPS), Medicare Part B vs. Part D billing & payment guidelines, Medicare Ambulatory Payment Classification PPS, Medicare Home Health PPS, Medicare Skilled Nursing Facility PPS, etc.

Certificates, Licenses and Registrations
Valid California Driver License.