Showe and Associates LLC
Executive Recruiting Services for the Managed Healthcare Industry
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Work for a major health system in a visible position leading managed care contract modeling and analytics in relation to negotiations with insurance payors. Job Summary Develops and maintains analytical tools, manages and trains staff, and uses data to provide recommendations on reimbursement methodology and rates for managed care contracts. Prepares financial analyses of current state, models the financial impact of potential reimbursement methods and rates, and determines the optimum....


Our client enjoy's a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package. What you will do as the Senior-Level Provider Contract Manager is develop, negotiate, manage, and lead intricate contractual, legal, and financial arrangements with providers to ensure the organization's members have great access to the highest quality, cost-effective....


New Medicaid/Medicare Health Plan in state of AZ is seeking a Chief Medical Officer who will be responsible for contributing to and achieving overall company goals for company growth and financial performance. This is an opportunity to be part of the ground up build of a Medicaid health plan and help secure new business opportunities.The Chief Medical Officer - CMO - will be responsible for strategic oversight of comprehensive medical policies including development, implementation, and....


Nationally recognized integrated health plan seeks a Director of Utilization Management to lead a CM / UM team in Southeastern Massachusetts. The Director of Utilization Management will: Manage criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims payment policies and processes.Support goals, contracts, and accreditation requirements of health plan by conducting reviews of clinical interactions and clinical documentation including reviews


Nationally recognized health plan seeks a VP Chief Medical Officer to provide system-wide strategic clinical guidance. The Chief Medical Officer will provide leadership in:Physical health and behavioral health care managementQuality ImprovementClinical operationsClinical informaticsShort and long-term program development and strategic planning for Medicaid and Medicare managed care.Leading medical teams for new business acquisition and turnaround initiatives,The design and implementation of....


Medicaid/Medicare Health Plan in state of Florida is seeking a Chief Medical Officer who will be responsible for contributing to and achieving overall company goals for company growth and financial performance. This is an opportunity to be part of the ground up build of a Medicaid health plan and help secure new business opportunities.The Chief Medical Officer - CMO - will be responsible for strategic oversight of comprehensive medical policies including development, implementation, and....

- Richmond, VA

Medical Director Growing integrated healthcare provider seeks a Medical Director to lead the company's utilization management clinical team in the state of Virginia. This is a remote role, but candidates must be licensed and live in Virginia. The Medical Director will:Oversee daily utilization management activities including reviewing requests and making coverage determinations for services and supplies for delegated lines of business.Act in a supporting role as medical manager and....


Leading health plan seeks a Medical Director - Psychiatry, to oversee the utilization management plan for various Virginia affiliated health plans. The Medical Director - Psychiatry should be and M.D. or D.O. with a speciality in psychiatry, and an active Virginia medical license. This is a remote role, but candidates need to live in Virginia. Requirements for the Medical Director Psychiatry: M.D. or D.O. licensure in Virginia, ABMS board certification in psychiatryCompletion of psychiatric....


Leading health plan seeks a Medical Director - Psychiatry, to oversee the utilization management plan for various California affiliated health plans. The Medical Director - Psychiatry should be and M.D. or D.O. with a speciality in psychiatry, and an active California medical license. Requirements for the Medical Director Psychiatry: M.D. or D.O. licensure in California, ABMS board certification in psychiatryCompletion of psychiatric residency in the U.S. or Canada, approved by the ACGME5+


Expanding Specialty Practice is seeking to add a Surgery Scheduler to it's health care team. * COMPENSATION is $16.00 per hour * Surgery Scheduler WORK SCHEDULE (approximate): 8:30am to 5:00pm. Monday through Friday. 40 hour work week. * EDUCATION / EXPERIENCE: High school diploma or equivalent. Must have A MINIMUM OF ONE YEAR Surgery Scheduler experience. Will work with numerous physicians and office personnel to include managers, nurses, mid-level practitioners. * JOB DESCRIPTION for Surgery

- Alexandria, VA

We are in search of a RN with at least 3 to 5 years progressive clinical nursing with primary care management of patient population. The qualified candidate must have:* strong oncology knowledge* Basic knowledge of managed care* Working knowledge of insurance coverage and procedures* Working knowledge of community resources; understanding of health care facilities and processes* Strong verbal and written communication skills* Strong interpersonal skills* Proficient computer skills Daily DOINGS

- Arlington, VA

We are in search of a RN with at least 3 to 5 years progressive clinical nursing with primary care management of patient population. The qualified candidate must have:* Strong oncology knowledge;* Basic knowledge of managed care;* Working knowledge of insurance coverage and procedures;* Working knowledge of community resources;* understanding of health care facilities and processes;* Strong verbal and written communication skills* Strong interpersonal skills* Proficient computer skills* MUST....


High Profile Biotechnology company in the Heart of Cambridge MA is hiring. The have been featured as top company to work for in 2018 and "Leading Technology" in biotechnology.The Head of Clinical Operations will be responsible for developing the global clinical development strategy and execution of clinical trials for all of Company’s clinical programs across multiple therapeutic indications. All therapeutic areas will leverage Company’s technology in CRISPR genome editing, cell....

- Philly or Harrisburg, PA

Medical Director- Philadelphia or Harrisburg, PAAmazing opportunity to join an MCO and improve quality of care and access to care for vulnerable populations. Physician will have an opportunity to lead and drive special projects and initiatives as a daily part of this role. Not all case review! Projects around quality, reducing red-admissions, controlling cost, wellness initiatives...and MORE! PRIOR managed care experience is NOT REQUIRED. The PA market has excellent leadership and....

- Richmond, VA

Highly regarded integrated health plan is searching for a Health Plan President to oversee the plan's business covering the state of Virginia and about 200,000 lives. The Health Plan President will have full P&L responsibility, and oversee a team of 250, with 5 direct reports. He or she will be the key point of contact for all Medicaid/Medicare products and services and government entities. Requirements for Health Plan President: Bachelor's degree in business, nursing or....


VP MEDICAL MANAGEMENT - RN - Managed Healthcare Remote Opportunity Location: Remote with Travel to NYC and Charlotte, NC, as Needed Innovative Medicare Advantage Plan has an immediate need for a Strong Dynamic Senior Level Nurse Leader with a decade of Managed Healthcare Medical Management Experience to join this exciting new Start-Up. Come join a successful leadership team as they continue to improve outcomes and quality for Medicare Beneficiaries. Reporting into the Chief Operations Officer,


Senior VP of Health Plan Strategy and Operations Location: 45 Miles Outside of Detroit, MI. Can be Remote, but travel to Michigan is expected otherwise. Innovative National Healthcare Consulting and Auditing Firm has an immediate need for a Strong Dynamic Managed Healthcare Senior VP of Health Plan Strategy and Operations. This Consulting Firm provides services to insurers, managed care and provider organizations involved with Medicare Advantage, Medicare Part D, Medicaid, Dual Programs, ACOs....


Exceptional Opportunity to join one of the top rated not-for-profit health plans headquartered in the New England area that is rated among the nation’s best health plans for member satisfaction and quality.The Sr. Manager is a strategic internal business partner serving as the lead subject matter resource for Medicare Advantage regulations and requirements. This position routinely meets with corporate line management to assess business operations against all Medicare Regulatory Requirements....


This opportunity can be in Nashville or anywhere remote in TN.This is an exceptional opportunity to do innovative work with the fastest growing division within a Fortune 50 organization.Reporting into the CMO, the ideal candidate will be responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical....

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