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Job Summary:
The CTO will be responsible for providing overall strategic direction for our
Clients technological planning and development functions. Provides highly
complex analysis for presentation to the executive level. Works with customers
to complete high-level design applying information technology as strategic
asset. Addresses major business processes in organization and documents them
through analysis of current effectiveness in supporting business goals. Provides
direction and support with regard to technical subject matter. The task requires
integrating hardware, software, and the customer. Systems integrators
participate with the customer in the strategic design process and translate
business needs into technical systems solutions. The ideal candidate will have
experience in providing a technology road map for large healthcare corporations.
Expert level knowledge in a number of IT topics and a comprehensive
understanding of all layers of technologies. Recognized industry visionary
through published writings in major industry periodicals, published books,
speaking forums and/or completed technology research. Experience in the
healthcare industry desired. Accountable for optimizing the flow of data and
ensuring ongoing adherence to data governance requirements for the entire client
enterprise. Focused on privacy and security and business enabling.
Main Duties & Responsibilities:
- Works with the CEO of the Company to
establish and communicate the Company’s overall technical objectives,
initiatives, and strategy
- Works closely with the CEO to develop and
implement long-range strategic objectives and operating policies and
procedures to ensure attainment of corporate technology goals
- Develops ideas for new products and
services, product design, or product enhancements and oversees the creation
and improvement of products and services that involve the Technology
department
- Develops leads and directs Technology team
capable of carrying out needed Technology initiatives
- Manages Technology budget
- Proven background in information security,
including program analysis, development, and testing activities
- Experience with compliance in the healthcare
industry, with specific knowledge of medical records, patient privacy and
confidentiality, and release of information preferred
- Deep understanding of data governance
issues, including US privacy and security laws and regulations
- Ability to communicate and work across many
disciplines, including C Level executives, line management, physicians,
psychiatrists, psychologists, clinical social workers, alcohol and drug
abuse counselors, information systems specialists, health information
specialists, financial managers, state and federal agency officials,
patients, clients and/or other stakeholders with whom the entity maintains
or transmits individually identifiable health information
- Previous experience with data privacy and
protection initiatives within the Financial Services industry desirable
- Technical knowledge of JAVA, J2EE
- Strong knowledge of healthcare and/or
physician IT market
- Ethical, energetic, team player, focused on
solving problems
Minimum Education:
BS degree in Computer Science/Engineering. MSCS and/or MBA desired.
Minimum Work Experience:
- 10 years of experience in the data
management profession, with a specific emphasis on data privacy / security
- 5 years of experience working with health
related information
- A minimum of 7+ years in management role
Interested candidates who have the credentials
and experience above, please send resume and current compensation to Lee Calhoon
at leecalhoon@aol.com. All
communications will held in strict confidence. Lee Calhoon & Co. is a retained
executive search firm which has specialized exclusively in the healthcare
industry since 1970. Visit our website at:
www.leecalhoon.com |
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PLEASE SUBMIT RESUME TO:
espsonia@pacbell.net
ES&P SEARCH
Contact: Sonia Varian
T 818.707.7118
V.P. OF MEDICAL
MANAGEMENT - MS - Will Relocate
Direct and coordinate activities of department and aid the chief officer
of the health plan and appropriate corporate staff in formulating and
administering organizational and departmental policies. Review analyses of
activities, costs, and operations and forecast data to determine department
progress toward stated goals and objectives. Perform duties to direct and
coordinate the medical management, quality improvement and credentialing
functions for the assigned health plan based on, and in support of the company’s
strategic plan; establishing the strategic vision and attendant policies and
procedures.
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. Familiarity of case management practices,
managed care, and Medicaid programs. Familiarity of National Committee on
Quality Assurance (NCQA) accreditation process and standards.
VICE PRESIDENT OPERATIONS
– MS - Will Relocate
Perform duties as chief liaison between the identified region and
Corporate policies & standards. Facilitate operational oversight for multiple
departments and identify opportunities for maintaining the most cost efficient
operation. Identification of operational efficiencies; meet regulatory and
client expectations and develop a “best practice” approach to all operations. In
support of the overall strategic plan, establish operational strategic vision,
objectives, policies and procedures for the Plan. Meet and exceed requirements
including organizational, state, compliance and contractual agreements. Ensure
cost effective, client and employee responsive programs are developed and
maintained throughout the Plan. Oversee all operations for the defined region,
including responsibility for Profit & Loss.
Bachelor's degree in Business Administration, Healthcare Administration or
equivalent. At least 8 years of experience in Management, Administration or
Operations in the Healthcare or Insurance industry. Master’s degree preferred.
V.P. COMPLIANCE - GA -
Will Relocate
Ensure regulatory compliance with state Medicare, Medicaid program and
state health care cost containment activities for the state health plan, of the
Corporation and its business subsidiaries. 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.
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. Current Management experience required.
DIRECTOR OF MANAGED CARE
- Florida
Responsible for the day-to-day operations of Florida Managed Care health
plan including Medicare and Medicaid lines of business. Assures timely reporting
of required information to the Managed Care Division, Finance Department,
Managed Care Executive Committee, Senior Management, Board of Directors and
contracted private and/or governmental agencies. Assures all contractually
required reports from the Florida lines of business are submitted to the
appropriate agencies. Develops relationships with key service providers and
vendors to facilitate collaboration and growth of the managed care programs.
Ensures the annual Business Plan is implemented and monitored, including
documented departmental and overall managed care goals and objectives. Oversees
the management of all departments operations. Provider Relations, Contracting
and Network: Quality Improvement, including Credentialing,
Development/Maintenance, Claims Administration, Member Services, including
enrollment/disenrollment and regulatory required member and provider materials.
Utilization and Case Management, Clinical Compliance and Informatics, Medical
Director/Medical Management policy, MIS managed care operations.
Education and Experience
Bachelor’s degree in Health Care, Public or Business Administration or related
field required. Masters degree preferred. Minimum 10 years experience with
managed care overall, with at least 5 of those years in a management role. A
background in Medicaid or Medicare managed care strongly preferred.
SALES MANAGER - Health
Plan - So. California
Sales Manager, in collaboration with the Director of Sales manages and
develops the staff and processes directed toward the enrollment of eligible
individuals to Managed Care Plans in CA. This includes Community Outreach and
marketing efforts, direct-to consumer marketing and/or counseling, development
of relationships with contracted providers and collaboration with Information
Systems, Case Management, Provider Relations and Contracting and Member Services
Departments to ensure the highest level of customer satisfaction.
General Essential Duties & Responsibilities. Knowledge and demonstrated
competency in interpreting, developing, executing and maintaining marketing and
sales activities within the regulatory and contractual requirements of The
Centers for Medicaid and Medicare Services (CMS) Medicare Advantage Part D
plans. Maintains all necessary sales/enrollment licensure or accreditations
required by CA - Medi-Cal or Medicare.(e.g., Licensed California Insurance
Agent). Ensures that all other sales staff do the same. Develops, ensures
appropriate approval, implements and maintains policies, procedures and
materials for sales and marketing that meet federal, state and contractual
requirements. Motivates self and enrollment team to meet or exceed enrollment
activity targets.
Certificates, Licenses and Registrations
Valid California Driver’s License with proof of liability insurance.
California Insurance Agent Licensure
COMPLEX CASE MANAGER
Health Plan - Excellent Compensation
Telecommute – on Site Case Management – Location: Stockton
To conduct telephonic and on-site case management and in a collaborative process
of assessment, planning, facilitation and advocacy for options and services
required to meet an individuals heath needs, using communication and available
resources to prevent readmissions and promote quality, cost-effective outcomes.
Builds effective business relationships with members and other internal and
external partners. Selects appropriate cases to open by screening from internal
or external referral sources. Manages cases by using essential activities of
case management including assessment, planning implementation, coordination,
monitoring and evaluation.
Promotes patient empowerment during care transitions by assisting the
patients/caregiver to develop skills to advocate for themselves. Facilitates
member care being delivered at the right level, right place, right time
according to the benefit plan by acting as a resource to case managers,
physicians and other member's health care team providers. Timely written
documentation shows evidence of all CCM and Care Transitions activities and
provides a status of the case for all of the internal case management team.
Facilitates qualify of care and service by referring any potential quality issue
to the Medical Director and Medical Management Department.
Registered Nurse (Current and active California RN license in good standing)
Case Management Certification preferred.
Three to five years experience in medical-surgical nursing.
Three years concurrent review / case management experience in the managed care
industry required. |
