Showe and Associates LLC
Executive Recruiting Services for the Managed Healthcare Industry
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Market Finance Executive | VP of Finance - Chicago Financially strong and positioned for exponential growth through market expansion and product diversification, this innovative healthcare enterprise is interested in an executive who is a forward- thinking financial strategist. VP will be a key player on the executive team, with focus on financial reporting, forecasting, enrollment, reimbursement, rate setting, identifying medical cost trends and overall leadership and development for the....

- Tampa, FL
new job!

Director, Case ManagementINNOVATIVE health plan truly values their nurses . The Director will be engaged in creating, defining and directing a complete Case Management Program across a diverse population.This will encompass needs analysis and planning; working with executive leadership to ensure targets are met for the annual operating plan; ensuring compliance with Corporate, State and NCQA standards. Director will be asked to develop and implement methods, policies and procedures to improve....


....SVP of Health Services | Executive Leader - Health Plan - Chicago HIGHLY VISIBLE opportunity working closely with the CEO. GENEROUS RELO- strong analytics support- collaborative team! You will establish the strategic vision for this plan, directing and coordinating the medical management, clinical services, and quality improvement and credentialing functions across the IL market. - Team - building and collaboration with internal and external constituents will be key. - Administer and....

- Tacoma, WA
new job!

MANAGER, UM – Behavioral Health Perform duties to conduct and manage the day to day operations of the utilization management functions to include denials. Communicate with departmental and plan administrative staff to facilitate daily operations of the utilization management functions. - Ensure compliance with established referral, pre-certification and authorization policies, procedures and processes - Facilitate ongoing communication between care management staff, utilization management....


Operations Director | Government Liaison - Health Plan Open due to promotion, this multi-faceted role will interface with external and internal stakeholders to maximize outcomes, quality, and profitability for national health insurer. Exceptional boss - strong growth potential. Director is responsible for the oversight of the many moving parts of enrollment, claims, and all other essential administrative components, with a focus on continuous improvement of operational efficiency as well as....

- Milwaukee, WI
new job!

Case Manager II - RN Innovative health plan truly values their nurses. 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 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. Activity will include advanced review of admissions through....

- SEATTLE/TACOMA/Wenatchee, WA
new job!

CARE MANAGER II (RN) - SEATTLEINNOVATIVE health plan is known for award winning programs of care. Join a growing team with exceptional leadership!Plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options Utilize....


Manager of Utilization Management – Dental Hygienist – TAMPA - FLORIDA RDH Salary is generous! Fortune 100 dental health insurance – so much room to grow – WONDERFUL benefits! Active Registered Dental Hygienist – any state Must work in Tampa – NICE relocation package! Perform duties to conduct and manage the day to day operations of the utilization management function. Communicate with staff to facilitate daily department functions.Review analyses of activities, costs, operations and forecast....


Sr. Contract Negotiator- HEALTH PLAN - Bedford,NH Very visible role engaging with CEO’s, CFO’s, Board of Directors to present data and work through contract specifics with providers. Company offers exceptional analytics support and generous benefits and career growth. Sr. Contract Negotiator will coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi specialty groups) and ancillary service agreements that are in accordance with corporate, health plan and State....

- Pittsburgh or Harrisburgh, PA
new job!

Medical Director – Pittsburgh, PA Physicians – are you looking for a purposeful career that will allow you to broadly improve care for the medically underserved? This organization offers this – and so much more…career growth is unlimited here. Assist the VP of Clinical Programs to direct and coordinate the physician component of the utilization management functions for the PA market. Great opportunity to influence your peers in the medical community. · Provides medical leadership for....

- Chicago, IL
new job!

Director, Finance – Health Plan – Chicago area Excellent mentor – unlimited career growth- newly expanding team…these are just a few reasons to consider a career with this national organization. Reporting to the SVP, the Director will oversee all activities of the business unit’s finance department and aid in formulating and administering organization financial policies and procedures. · Monitor business processes and systems to assure integrity in information and systems · Oversee preparation

- Appleton or Eau Claire, WI
new job!

Behavioral Case Manager – Appleton or Eau Claire, WI – 3 new positions - CHOOSE a location! New market area will need clinician who enjoys some field work and travel within northern WI…fully integrated program of care. -Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health....

- Appleton, WI
new job!

Medical Management Trainer – Appleton, WI Innovative national health plan! Newly created role will provide hands on training to clinical staff in Medical Management – RN’s and social workers. Great opportunity to influence quality of care for this underserved population. · Develop and conduct clinical educational classes/course · Develop, conduct and ensure maintenance of Case Management (CM) education · Conduct interqual training for CM staff · Conduct training to ensure proper inpatient....


Director, Clinical Operations (Behavioral Health) Be part of the leadership team for a market expansion. Talented team and strong opportunity to make a difference in your career and in the lives of the medically underserved. Director will oversee clinical functions in all service areas including: intensive case management (ICM), utilization review (UR), provider training and care coordination in collaboration with other senior leaders. Director will work to manage complex behavioral health....

- Chicago, IL
new job!

Job description Looking for a Change Agent/Managed Care experience/RN License/Familiar with Provider/Payor side/ Company doubling/Rapid Growth/ Medicaid & Fostercare ProductReporting to the Plan President, the VP Medical Management will 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....


Our firm is in search of a qualified candidate with 5+ years of Medicare and/or Special Needs Health Plan experience. Preferably with a Medicare Health Plan. A Bachelor’s degree is required. In this role you will be Managing the development, implementation and administration of Medicare Special Needs Product (SNP) and you will be coordinating with Corporate on execution of Medicare SNP strategy. In this role you will have direct reports, thus you should have strong leadership experience.....


Join our global manufacturing client as the Plant EHS Manager. Participate on the Site Leadership Team, with the primary focus of elevating safety and environmental performance for achieving world-class EHS performance. Tactically deploys the strategy and safety vision for the site team. Effectively execute the strategy to grow the plant EHS team, enabling the talent, and skills necessary to drive continuous improvement towards world-class safety and environmental performance. QUALIFICATIONS:....


Vice President, Actuarial Services & Risk Management (Medicare) Job descriptionPosition Purpose: Provide expertise and actuarial support to ensure efficient and effective operations of the commercial product lines.Develop actuarial pricing models for commercial and Exchange products to calculate the required premium levels in the open enrollment environment.Deliver pricing models that reflect the impact of ACA structural rating rules and develop various scenarios to identify pricing....


Job description Looking for a Change Agent/Managed Care experience/RN License/Familiar with Provider/Payor side/ Company doubling/Rapid Growth/ Medicaid & Fostercare ProductReporting to the Plan President, the VP Medical Management will 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....

- Sacramento, CA

Job descriptionPosition Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Reports to Chief Medical Director. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental....

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