Showe and Associates LLC
Executive Recruiting Services for the Managed Healthcare Industry
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Case Manager II - RN - office or field based - TWO positions This health plan has received numerous awards for their programs of care ! They offer generous benefits and PLENTY of opportunity to grow in your career.Innovative health plan truly values their nurses. RN will coordinate continuum of care for select members with complex medical and/or behavioral health conditions to ensure they receive the highest quality most effective care while maintaining cost effectiveness. PCP, specialist, and


Seeking: RN, BSN, MSN Leader with experience in Complex Case Management, Disease Management, Utilization Management, Care Management, Quality in a managed care setting with at least 5-7 years experience. Job description OVERVIEW OF POSITION: Responsible for the oversight, management and optimization of all CQI, UM and Care Management activities as they relate to inpatient, social service, home health, DME and other healthcare delivery programs for the enterprise. Participates in the....


Nationwide Search for the Best in Class of Contract Negotiators in Value-Based and Hospital Contracting. This national leader in healthcare, a Fortune 100 company which provides innovative solutions to over 12 million members, believes their most important assets are its employees. Join their team and help transform the health of the communities they serve, one person at a time. This starts with you, from your benefits to your retirement plan and reaches outwards to community support and....


Seeking local RN leaders with Case Management experience to Manage the day to day operations of the case management department for this healthcare enterprise. Review analyzes of activities, costs, operations, and forecast data to determine progress toward stated goals and statistical/financial purposes. Promote compliance with federal and state regulations and contractual agreements. Develop, implement and maintain compliance with policies and procedures regarding medical case management.....


Seeking Director to head up Membership Administration Systems for this healthcare enterprise. A Highly visible role for Healthcare Leader with experience in Operations, Membership Services in the implementation of Healthcare Health Systems and Large scope multi-year project management. Job description Responsible for the management and leadership of a range of process improvement and process management activities. Activities managed include planning, performing, and implementing process....


Seeking local RN candidates for Manager, Prior Authorization & Referrals. If overseeing day to day functions of the call center that provides preauthorization and referral services to physicians for plan members is your thing. ... then we need you on our team.Oversee preauthorization nurses and referral specialists in their day to day activities including management of talk times, service levels, abandonment rate, and other key quantitative/qualitative factorsDevelop, implement and....

- Los Angeles, CA

Reporting into the Sr. V.P of Clinical Operations, this position will be in charge of overseeing, managing and optimization of all CQI, UM and Care Management activities as they relate to inpatient, social service, home health, DME and other healthcare delivery programs within the organization Individual will participate in the development, implementation and maintenance of all programs to ensure that patient care maximizes quality and continuity by utilization of appropriate resources and....


Nationwide Search for Director to lead and coordinate all National Labor Relations to include national initiatives, collective bargaining as well as day-to-day labor relations for Healthcare enterprise.Serves as a key interface between National Labor Relations and its key customers, ensures positive labor relations climate through effective communications, collaboration, persuasion, and problem-solving; demonstrating knowledge and understanding of the national labor relations program and....


Leading Global Pharmaceutical company with office in Waltham Massachusetts Manager, Health Economics & Outcomes Research (HEOR) Position Summary: The Manager for Health Economics & Outcomes Research (HEOR), will be responsible for supporting HEOR activities for company's products. This individual will contribute to evidence generation, development of strategy, data analysis and dissemination and support the HEOR Senior team members (Directors, Senior Directors).....


GLOBAL PHARMACEUTICAL COMPANY IS HIRING A HEAD OF MEDICAL AFFAIRS FOR RENAL Renal Cardio Medical Head (Executive Director) The Renal Cardio Medical Head is a member of the Renal-Cardio Therapeutic Area (RCTA) leadership team and leads the Renal Cardio Core Medical Team. The position can be either a Senior Director or Executive Director based upon the individual's experience. The Medical Lead is knowledgeable of the actions of regulatory bodies, in particular, knowledge of the FDA. He/She has....


Three Medical Directors needed The Medical Director is a board-certified physician who has a history of clinical practice, and has significant experience in the cardio therapeutic area, Endocrinology or Renal, Nephrology therapeutic areas. The Medical Director is knowledgeable of the actions of regulatory bodies, in particular FDA, and has experience in clinical trials. An ideal candidate should have significant experience in renal cardio disease management and would thrive on proactively....


Nationwide Search for Actuary and Associate Actuary (Individual Market) for Chicago, Milwaukee, and Calabasas Job descriptionPosition Purpose: Conduct analysis, pricing and risk assessment to estimate financial outcomes. Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomesDevelop probability tables based on analysis of statistical data and other pertinent informationReview insurance plans and calculate required premium....


Nationwide Search for Director, Utilization Management (RN) for large Fortune 100 enterprise. Job descriptionOversee operations of the referral management, telephonic utilization review, prior authorization functions, and case management programs. Ensure compliance government and contractual guidelines and the mission, philosophy, and objectives of Corporate and the health plan. Support and perform case management, disease management, and on-site concurrent review functions as necessary.....


We are in search of a Medical Director who is an actively practicing Board Certified Physician working with a Medicare/ Geriatric population in a LONG TERM ACUTE CARE SETTING. We will consider Board Certifications (ABMS approved Board) in the following specialties: Internal Medicine, Family Practice, or Emergency Medicine. Our client prefers you do have experience working in a managed care setting. While our client prefers you live in the Hollywood/ Sunrise, FL region, they will consider those


We are in search of a Medical Director who is and actively practicing Board Certified Physician Board certified by the American Board of Psychiatry and Neurology. This is a role where you are directing and coordinating the medical management, quality improvement and credentialing functions. You should be willing to practice clinically ONE day a week. Salary plus 20% bonus or higher We can only consider those who are Board certified by the American Board of Psychiatry and Neurology. Current....

- Pittsburgh, PA

Home Healthcare Manager Our client company is a growing home health care / managed care organization in the Allegheny county area. They are seeking a Home Health Agency Manager on a full-time/direct basis. This opportunity will offer a career path with the overall responsibility for facility growth and employee development. The selected individual will have the following responsibilities:Oversee operations in a Medicare/Medicaid certified home health agencyOversee day to day agency operations,


Develops and maintains professional relationships with internal and external customers to provide comprehensive medical and scientific support to company initiatives in assigned therapeutic areas. Facilitates information, education, and research activities for physicians and ancillary healthcare professionals regarding current and future therapies in development or commercialized. Works closely with other personnel to ensure information, education, and research needs of healthcare....


POSITION TITLE: Executive Director-Accountable Care Organization POSITION LOCATION: Michigan POSITION DESCRIPTION: The individual in this role will be a senior leader in the ACO department and will be expected to contribute to initiatives that advance the enterprise objectives, scaling best practices and actively engaging with other local market and ACO department leaders to coordinate the success of the ACO and CIN strategy. It will be essential for this position to work closely with a wide....


Are you a RN with a strong Quality background with hands on experience with NCQA accreditation expereince? Do you have this expereince in a Managed Care setting? If you have answered YES to these two important questions, read on… you just might be a match for this job! THIS IS A NEWLY CREATED POSITION AT THIS COMPANY. Here is more of what our qualified candidate looks like:7+ years of healthcare operations experience, including quality improvement experience. Managed care experience is....


We are currently recruiting for a NASH Medical Director, Medical Affairs within Global Medical Affairs (GMA) and the Chief Medical Office (CMO). Working under the leadership of the Global Therapeutic Area Head, this role develops a comprehensive medical strategy for several products in development to treat Non-Alcoholic Steatohepatitis (NASH). They will work closely with Clinical Development colleagues within Research & Development as well as colleagues within Global Evidence & Value....

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