The National Managed Care Leadership Directory 2008

$249 Book; $595 CD-ROM

The ideal tool for networking, recruitment, research, sales prospecting and more!  Over 445 pages, and 6,950 executive listings from over 850 companies. Companies reported include health plans, provider networks, PBMs, administrative organizations (quality improvement organizations, utilization and disease management organizations, and TPAs) and specialty organizations (dental, vision and behavioral.)

The 2008 Directory reflects extensive changes: 26.9% (1871 records) of 2008 Employee Listings are new for 2008; 2.3% (163 records) of 2008 Employee Listings had a change in job function with the same employer for 2008; and 70.72% (4,919 records) of the 2008 Employee Listings were unchanged from 2007. 25.4% of the 2007 Employee Listings (1,765 records) were deleted for the 2008 Edition.

How to Get Your Copy: http://www.healthquestpublishers.com/ or call 209.577.4888.

Cenpatico Behavioral Health (CBH), a subsidiary of Centene Corporation., a leading multi-line healthcare enterprise, has experienced phenomenal growth, and as a result we have an opportunity in Austin, Texas for a Manager of Provider Relations & Contracting.

In this dynamic role you will implement development activities for the recruitment, contracting and retention of providers, negotiating contracts and developing strategies and methodologies for specific network development initiatives.

Qualifications include a Bachelor's degree or equivalent experience in a related field, Master's degree preferred; 3-5 years of experience in contracting, network development and/or provider relations with project management and supervisory/lead experience. Experience in a healthcare or insurance environment, preferably in Medicaid is also required.

A career with Centene is an opportunity to make a difference in an environment where you have the support you need to succeed, amazing colleagues, and the benefits of a comprehensive total rewards package. We offer our employees competitive pay with bonus potential, a 401(k) program with matching benefit, tuition reimbursement program and receive paid vacation, sick and personal leave plus 12 paid holidays annually. Join our team and experience the rewards!

To find out more about our organization and to apply, visit us online: http://www.centene.com/ 

Equal Opportunity Employer  

Come join a growing company that is making a difference in the delivery and management of healthcare services. Hill Physicians Medical Group is the largest network of independent physicians in Northern California.

You will support senior management and physician leadership by:

• Managing the Hill Physicians provider network.

• Assisting providers in understanding and enhancing their performance in performance based compensation programs, and developing/presenting analytical analysis regarding the physician network.

• Facilitating meetings both internally and externally, including primary care physician and specialist panel meetings.

Ideal candidates will have:

• A BA/BS in Healthcare, Business or related work experience.

• Previous managed care experience in areas of provider relations, provider contracting and/or medical network development.

• Strong analytical/problem solving skills, excellent written and verbal communications skills, and the ability to prioritize and lead projects are necessary.

• Proficiency in MS Office required.

• Ability to travel to and participate in business meetings outside of normal business hours.

We offer competitive compensation and benefits, a 401k plan with company match, paid time off (PTO) and holidays, casual work environment and the opportunity to use your talents to make a positive difference in our company.

Send resume to Hill Physicians Medical Group c/o PriMed, P.O. Box 1161, San Ramon, CA 94583; Fax: (925) 820-1826, or E-mail: human.resources@hpmg.com 

For additional information visit www.HillPhysicians.com 

Lee Calhoon & Co., a healthcare executive search firm, has been retained to evaluate candidates for the position of Director, Quality and Care Management.  The position reports to the Chief Medical Officer and is located in Chicago , Illinois .

Position Summary:  This position is responsible for developing and implementing a quality improvement and utilization management program that is consistent with the philosophy of the health plan.  Leads, coordinates and ensures documentation of all accreditation and State performance activities for the health plan.  Develops and implements a comprehensive corporate strategy to ensure HEDIS and CAHPS improvement.  Oversees the utilization management, case management and disease management programs.  Responsible for ensuring that Meridian ’s programs are compliant with National Committee for Quality Assurance (NCQA) standards as well as State and federal regulatory requirements.

Essential Functions:

• Oversee the development, implementation and annual evaluation of the corporate Quality Improvement Plan and Care Management Program.

• Monitor and ensure compliance with all State regulatory requirements, including the State performance measures.

• Serve as the leader for HEDIS and CAHPS reporting and improvement activities.

• Lead and direct the organization’s NCQA accreditation survey preparation for managed care organizations and provide support for all department directors and managers to ensure that the compliance requirements are met for each area.

• Ensure that the utilization management process is well organized, efficient, clinically appropriate and meets all of the regulatory requirements, including NCQA standards.

• Develop systems and processes for prospective, concurrent and retrospective utilization review that are based upon medical necessity guidelines, clinical protocols and recognized standards of care.

• Collect, analyze and maintain data regarding utilization of medical services.

• Oversee the identification, tracking, resolution and response to all denials and appeals in compliance with NCQA standards.

• Oversee the development and implementation of Case Management and Disease Management programs for enrollees identified as a priority within the health plan membership.

• Ensure that appropriate policies and procedures are in place to support all care management, quality improvement and disease management activities.

• Oversee the Quality Improvement Committee structure and participate in committee meetings as appropriate. 

• Promote a provider-friendly, customer service oriented philosophy within the Quality Improvement and Care Management departments.

• Identify and implement opportunities to enhance efficiency through the use of the MCS system as well as departmental process improvements.

• Develop and monitor the budget for quality improvement and care management activities and ensure that sufficient resources are assigned to meet department goals. 

• Prepare monthly and quarterly reports for submission to the leadership team and the Board of Directors.

• Serve as a liaison for the health plan concerning quality and care management activities, including participation in external meetings and coordination with external entities. 

• Maintain strict confidentiality of employee and organizational information in accordance with HIPAA and State privacy regulations.

Job Requirements:

Education:

• Bachelor’s degree in nursing.

• Current Illinois license as a Registered Nurse or license eligibility required.

• Masters degree in nursing, health care administration or related field preferred.

Experience:

• Three to five years of experience in quality improvement and utilization management.

• Previous experience with case management and disease management preferred. 

• Previous experience in managed care and Medicaid programs.

• Prior successful completion of an NCQA accreditation survey for managed care.

• Previous management and supervisory experience.

Knowledge:

• Knowledge of the National Committee on Quality Assurance (NCQA) standards for managed care organizations.

• Knowledge of HEDIS and CAHPS reporting processes.

• Knowledge of health care utilization management processes and documentation.

• Knowledge of authorizations, medical records and claims data.

We welcome sharing additional information about this engagement with you personally, and would appreciate any referrals of colleagues who may have the credentials we are seeking.  For additional information contact: Bill Fedora, Principal at 610-469-9053 or email at wfedora@leecalhoon.com.   Complete Confidentiality Assured

Bill Fedora

Principal

Lee Calhoon & Co.

1621 Birchrun Road

Birchrunville , PA 19421

Phone: 610-469-9053

Fax: 610-469-0398

www.leecalhoon.com 

Interested Parties Please Contact: 
Executive Search & Placement (ES&P Search)
Phone: 818-707-7118 
For confidential consideration please submit resumes to Sonia Varian: espsonia@pacbell.net  

Interested Parties Please Contact: 
Executive Search & Placement (ES&P Search)
Phone: 818-707-7118 
For confidential consideration please submit resumes to Sonia Varian: espsonia@pacbell.net
 

• Membership Diagnostics: Analyzing Shifts and Creating High-Impact Future Strategies, July 24th, 2008
• Medicare Product Development and Diversification for the 2010 Benefit Year, October 16th, 2008
• Care Management Web Summit, November 6th, 2008
• CD-ROMs of past events
• Upcoming Events

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