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Job Description: Outpatient Radiology Business Manager Outpatient Radiology Business Manager Location: Fairfield County, CT Salary: $88,000-$117,565 Experience: 4.0 year(s) Job Type: Full-Time Job ID: J136733       About the Opportunity A respected hospital in Fairfield County, CT is actively seeking a driven and highly organized individual for a promising opportunity on their staff as their Outpatient Radiology Business Manager. In this role, the Outpatient Radiology Business Manager will assist in the implementation of projects/programs and play a critical role in any changes designed to promote growth of the radiology department. Apply today! Company Description Hospital Job Description The Outpatient Radiology Business Manager: Utilizes appropriate resources to improve technical/business practices Drafts the operational budget for the radiology department Monitors expenditure trends within the radiology Management Team Drafts fiscal policies and procedures for the radiology Department Works in conjunction with Materials Management to serve as a gatekeeper for all vendors and new product access Participates in cost containment activities Helps radiology managers identify and budget capital equipment needs and track capital purchases Maintains the radiology department repository of utilization, financial other business reports Compiles statistical data on procedure costing, service utilization and productivity analysis to include quality reporting programs Required Skills Bachelor’s Degree in Finance or Business related field 4-5 years of business management experience Ability to multitask Excellent communication skills Ability to meet stringent deadlines Highly organized Ability to communicate effectively with all personnel within department and organization

Job Description: Quality Improvement Nurse (RN) Quality Improvement Nurse (RN) Location: Bronx, NY Salary: $85,000-$90,000 Experience: 5. year(s) Job Type: Full-Time Job ID: J137081       About the Opportunity A healthcare facility in New York City is actively seeking a licensed Registered Nurse (RN), with a strong Quality Improvement background, for a promising position with their growing medical staff. In this role, the Quality Improvement Nurse (RN) will be responsible for assisting the Quality leadership in the overall implementation and monitoring of the quality program for health plans line of business. Apply today! Company Description Healthcare Facility Job Description The Quality Improvement Nurse (RN) will be responsible for: Assisting and facilitating in the monitoring and evaluating the quality and appropriateness of care/services Monitoring member satisfaction Participating / managing initiatives for improvement and evaluating the effectiveness of interventions Providing consultation and direction internally within the Nurse Care Manager and Quality Department and externally with vendors to ensure programs and services are implemented at the highest standards and patients receive the highest level of care Participating in quality assurance, compliance, and risk management Required Skills 5+ years of Quality Improvement experience Bachelor's Degree in Nursing NYS Registered Nurse (RN) license Previous experience working in a Managed Long-term Care setting Solid assessment, clinical, and documentation skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills CPHQ

Job Description: Case Management Nurse Manager (RN) Case Management Nurse Manager (RN) Location: New York, NY Salary: $81,000-$86,000 Experience: 0.0 year(s) Job Type: Full-Time Job ID: J130854       About the Opportunity A New York City healthcare organization is currently seeking a licensed Registered Nurse (RN), with a strong Case Management background, for a promising Managerial position with their growing staff. In this role, the Case Management Nurse Manager (RN) will be responsible for effectively managing the daily operations / workflow and supervising clinical and non-clinical staff to provide support for the organization's Care Management programs. Company Description Healthcare Organization Job Description The Case Management Nurse Manager (RN) will be responsible for: Assisting in developing strategic plan by partnering with Assistant Director and Fund management to identify opportunities that have direct impact on clinical and financial outcomes Accessing and analyzing all processes on an ongoing basis to determine their effectiveness, eliminate inefficiencies and make recommendations to senior management to improve workflow, operations, and staff performance Coordinating activities between clinical programs, communication, and report requirements to maintain operational efficiencies and to be in compliance with the Department of Labor (DOL), Summary Plan Description (SPD) departmental protocols and clinical policies and procedures Interacting and collaborating with other departments (e.g. Claims and Provider Relations) in troubleshooting, problem solving, and exchanging information in conjunction with maintaining effective communication with providers and members Staff development, clinical orientation, ongoing education, and training programs to meet the changing needs of the Department Continually assessing clinical staff performance against internal and external departmental and industry standards Required Skills 5+ years of Advanced or Specialized work experience in Care Management programs (Utilization / Case Management / Appeals Programs) within a Managed Care organization; 2+ years of progressive Leadership and Management experience Bachelor’s Degree in Nursing, Business or Health Care Administration or equivalent years of work experience required; plus Current NYS Registered Nurse (RN) license Working knowledge of Milliman / InterQual guidelines or other regulatory protocols (i.e. Medicare), claims processing, medical coding (ICD-9, HCPCS, CPT) and interpreting provider contracts Strong Medical / Clinical background Microsoft Office/Suite proficient Solid critical thinking and analytical skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized $ Desired Skills Previous management experience and CCM certification

Job Description: Director of Utilization Management (RN) Director of Utilization Management (RN) Location: Brooklyn, NY Salary: $110,000-$135,000 Experience: 5. year(s) Job Type: Full-Time Job ID: J137164       About the Opportunity A healthcare organization in New York City is actively seeking a licensed Registered Nurse (RN), with a strong Utilization Management background, for a promising Director-level position with their growing medical staff. Reporting directly to the Vice President of Care Management, the Director of Utilization Management (RN) will be responsible for the development, implementation and coordination of quality driven programs, including evaluation of the Utilization Management Program. Apply today! Company Description Healthcare Organization Job Description The Director of Utilization Management (RN) will be responsible for: Providing leadership emphasizing utilization management program development, process improvement, implementation and measurement of quality metrics Interpreting and implementing utilization management criteria and clinical standards Creating, developing and implementing policies and procedures in accordance with regulations and contract compliance with the State of NY Department of Health Contract, regulatory and accreditation requirements Reviewing quality assurance standards; studying existing policies and procedures; and, interviewing personnel and customers to evaluate effectiveness of utilization management program Leading and/or participating in quality initiatives and activities as designated by Continuous Quality Improvement Committee Acting as a key contact source in accreditation processes Improving the quality of care and services, work performance and department processes Performing quality-assurance functions to accomplish business coordination, monitoring, and reporting of quality-assurance studies according to the CM/QA plan Compiling statistical data and writes narrative reports summarizing quality assurance findings Assuring timely identification of problems and correction of deficiencies Assisting departments with the coordination of audit information, and recommends appropriate data-gathering mechanisms, procedures, etc. Required Skills 5+ years of Utilization Management experience Bachelor's Degree in Nursing, Business, and/or Healthcare Management NYS Registered Nurse (RN) license Strong Management background Knowledge of current Care / Case / Disease Management methodologies and Program Development Working knowledge of Interqual or Milliman Knowledge of the Healthcare delivery system Solid assessment, clinical, and documentation skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively

Job Description: Utilization Management Manager (RN) Utilization Management Manager (RN) Location: Brooklyn, NY Salary: $100,000-$110,000 Experience: 3.0 year(s) Job Type: Full-Time Job ID: J137165       About the Opportunity A healthcare organization in New York City is currently seeking an experienced, licensed Registered Nurse (RN), with a strong Utilization Management background, for a promising Manager-level position with their growing medical staff. Assuming a leadership role within the Medical Management Department, the Utilization Management Manager (RN) will be responsible for overseeing the authorization of covered services for eligible members  and insuring high quality, cost-effective patient care and appropriate allocation of member services and resources. Apply today! Company Description Healthcare Organization Job Description The Utilization Management Manager (RN) will be responsible for: Overseeing the provision of utilization management functions, including: pre-certification; concurrent review; discharge planning; etc. Developing departmental process workflows for utilization management functions Hiring, supervising and managing a team of nursing professionals Maintaining staff productivity, effectiveness and efficiency Developing key indicators for staff; auditing staff to achieve key indicators and optimal outcomes Developing and analyzing operational and analytical reports needed to monitor and track operational efficiency Ensuring compliance with the goals of the Medical Management Department and the overall organization Conducting daily, weekly, monthly and quarterly meetings as needed with staff to review process issues Troubleshooting any issues that utilization management staff are experiencing during the authorization process Participating in quality improvement activities Required Skills 3+ years of experience in the Authorization of Services within a Healthcare Management company; 3+ years of Managed Care experience; and, 3+ years of experience in a Management position Associate's Degree in Nursing NYS Registered Nurse (RN) license Utilization Management / Review background Solid assessment, clinical, and documentation skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Bachelor's Degree in Nursing CCM, CPHM and/or CMCN certification

Job Description: Small Group Program Manager Small Group Program Manager Location: Parsippany, NJ Salary: $100,000-$100,000 Experience: 4.0 year(s) Job Type: Full-Time Job ID: J135861       About the Opportunity An established health services company headquartered in Parsippany, NJ is actively seeking a driven and highly organized individual for a rewarding opportunity on their staff as a Small Group Program Manager. In this role, the Small Group Program Manager will be responsible for the facilitation and management of the company's small group business program,  including sales and retention of business in New Jersey. Company Description Health Services Company Job Description The Small Group Business Manager: Identifies, engages, manages, cultivates and develops new and existing brokers, consultants and general agent relationships Oversees a personal sales and retention goal in addition to managing a team of sales and retention associates Participates in performance management and the overall small group production goals Ensures timely and accurate completion of all internal and external business documentation, applications and process Promotes the value, benefits and brand attributes to the marketplace and community to help support the organizations reputation, mission and all sales and retention efforts Manages the relationship and coordinates the exchange of information and communicates the importance of accountability to internal and external business partners Maintains timely and accurate recordings of sales activities and clients interactions in the CRM on a regular and consistent basis Facilitates the initial and ongoing training for general agents that achieve measurable results Seeks, supports and helps facilitate individual and large group sales opportunities where appropriate for the organization Works directly with Operations, and Marketing with support from sales management Oversees resolution of items Attends group sponsored open enrollment, health fairs and broker/GA events Performs miscellaneous duties as assigned Required Skills Bachelor's Degree or equivalent experience 4+ years of sales, marketing, underwriting or related business experience 5+ years of experience in employee benefit programs Insurance license Excellent active listening skills; Solid written communication skills in formal and informal settings Strong presentation skills Ability to interact well with co-workers and outside contacts Ability to respond to multiple tasks and leadership direction while balancing competing demands Exhibits strong leadership by including appropriate people in decision making process Understands group dental healthcare terminology Strong analytical and problem-solving skills to quickly and effectively facilitate customer problem resolution Proven commitment to excellence in customer service. Exhibits strong follow through skills. Familiarity with contracts, Evidence of Coverage and other marketing collateral   Desired Skills Established relationships with brokers and consultants Knowledge of health care marketing and broker channels

Job Description: Digital Project Manager Digital Project Manager Location: Tampa, FL Salary:  Experience: 3.0 year(s) Job Type: Temporary / Consulting Job ID: U1010748       About the Opportunity A healthcare company in Florida is currently seeking a new Digital Project Manager for a great opportunity with their growing staff. In this role, the Digital Project Manager will be responsible for implementing the strategy for digital marketing and communications initiatives that serve to enhance the company's reputation and providing efficient service to members and providers. Apply today! Company Description Healthcare Company Job Description The Digital Project Manager will: Implement the group of companies' digital communication strategy to various external audiences Collaborate with cross-functional business areas to assess needs, compile requirements and prioritize requests Compose business requirements and ROI documents Manage project management and content development and delivery across multiple websites and other digital channels, working closely with other business areas Conduct quality control and user acceptance testing Accurately scope projects; collect and implement requirements; and, facilitate communication and measure performance to optimize the communication capabilities of the company websites, internet search and mobile Support development of new websites and digital communications vehicles as the company adds new lines of business, subsidiaries, etc., and participate in the integration of web properties for company acquisitions Required Skills 3+ years of experience managing Matrix and Cross-Departmental Projects with a high level of client interactions Bachelor's Degree in Business Administration, Communication, Marketing, or a related field Knowledge of Project Development life cycles, Web Technologies and Web Development processes Solid problem solving and time management skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively

Job Description: Associate Director of Case Management / Retention Associate Director of Case Management / Retention Location: New York, NY Salary:  Experience: 1.0 year(s) Job Type: Temporary / Consulting Job ID: U1004397       About the Opportunity A nonprofit organization in New York City is currently seeking a dedicated and experienced professional to joint heir staff as a Associate Director of Case Management / Retention. In this role, the Associate Director of Case Management / Retention will be responsible for providing management, oversight, staff development, and performance management to the Case Management Retention team. Company Description Nonprofit Organization Job Description The Associate Director of Case Management / Retention will: Manage the Case Management Retention team, including: hiring and training; department oversight; individual staff evaluation; and, developing and implementing new initiatives to increase performance Ensure department meets monthly contractual retention goals Manage the administrative tasks of the department, including billing, data entry and analysis, and department reporting Work in conjunction with the Associate Director of Career Services to monitor the replacement jobs process, completing all necessary reporting and analysis Monitor staff outreaches to DHS Liaison and Business Development team for assistance in capturing milestone documentation and maintaining customer contact Develop and implement new and/or improved Case Management initiatives to ensure all clients have appropriate resources and services Conduct staff evaluations and provide staff development Perform management duties, including: the distribution and collection of carfare; taking customer complaints; and, participating in all management meetings Required Skills 1+ year of Management experience working with the Economically Disadvantaged, Homeless, Welfare Recipients and other Disadvantaged populations Bachelor's Degree in Counseling, Social Work, or a related field Knowledge of Case Management theories of practice Microsoft Office/Suite proficient Solid time management and problem solving skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Bilingual (English and Spanish)

Job Description: Senior Account Manager Senior Account Manager Location: New York, NY Salary: $90,000-$110,000 Experience: 5.0 year(s) Job Type: Full-Time Job ID: J137189       About the Opportunity A premier regional health information organization (RHIO) is actively seeking a self-motivated and dynamic individual for a promising opportunity on their staff as a Senior Account Manager. In this role, the Senior Account Manager will be responsible for all participant account activities including activity management, outreach and training, selling new services, and consent management. Apply today! Company Description Regional Health Information Organization Job Description The Senior Account Manager will be responsible for: Utilization of the organization's platform Developing areas of consent acquisition and strategies to drive consent Oversight of user management and training Acting as a central point of contact for all corporate information Required Skills Bachelor's Degree 5 years of total professional experience 2+ years of related experience including account management of hospitals, nursing homes, and/or large providers Knowledge of MS Office and Salesforce.com Understand and capitalize on the uniqueness of a C-level meeting, a technology meeting, and a business level meeting Able to provide software demonstrations while focusing on the value and benefits to the member organization Able to manage account management and sales meetings with mid-sized audiences Strong analytical and interpersonal communication skills including process, writing, problem solving, customer relationship, organizational and conflict resolution

Job Description: Network Management Representative Network Management Representative Location: Tampa, FL Salary:  Experience: 1.0 year(s) Job Type: Temporary / Consulting Job ID: U1008101       About the Opportunity A Florida-based healthcare company is actively seeking a personable professional to join their staff as a Network Management Representative.  In this role, the Network Management Representative will be responsible for providing quality, accessible and comprehensive services to the company's provider community. Company Description Healthcare Company Job Description The Network Management Representative will: Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns Develops, maintains, and enhances relations with providers to foster cooperative business relationships Coordinates prompt claims resolution through direct contact with providers and claims department Provides assistance with policy interpretation Researches, analyzes and recommends resolution for provider disputes as well as issues with billing and other practices Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery Tracks customer service patterns/trends and identifies training when appropriate Drafts training documents and conduct provider refresher training at onsite provider locations or by telephone Researches issues that may impact future provider negotiations or jeopardize network retention Required Skills 1+ year of Customer Service experience High School Diploma Computer savvy Microsoft Office/Suite proficient Solid time management and problem solving skills Exceptional phone etiquette Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively

Job Description: Corporate Director - Case Management Corporate Director - Case Management Location: Newton, MA Salary: $125,000-$140,000 Experience: 3.0 year(s) Job Type: Full-Time Job ID: J137490       About the Opportunity An established healthcare provider in Massachusetts is actively seeking a self-motivated and compassionate healthcare professional for a promising opportunity as their new Corporate Director of Case Management. In this role, the Corporate Director of Case Management provides oversight for resident care delivery processes (clinical and rehab) in our Post-Acute (HC/SNF) settings. Apply today! Company Description Healthcare Provider Job Description The Corporate Director of Case Management will: Manage systems related to Medicare A, Managed Care, Medicaid, and ACO processes Evaluate current system workflows Identify gaps and create solution plan Deliver a strategic, proactive approach to an effective staff orientation and training program Engage inter-professional team members at all levels of the organization to participate in system design (practice/competency/documentation) Coordinate relevant clinical policy/procedure revisions Identify and manage key quality outcome data measures and methodology Create/implement a regularly scheduled communication plan   Required Skills Bachelor's Degree Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Language Pathologist license 3-5 years of divisional or corporate experience in post-acute care settings Expert knowledge of current state and federal government post-acute care regulations Expert Leadership skills In-depth knowledge of case management and resource utilization review practices Demonstrate ability to work effectively with all levels of the organization Demonstrate expertise in critical thinking and analytical skills Expert clinical skills and ability to provide educational programs to all levels of the organization Strong expertise in Medicare, Managed Care and ACO development Proficient to expert in the use of software systems conducive to developing and presenting system deliverables including, but not limited to Microsoft Office Suite Desired Skills Master's Degree Vendor management / business partnership experience Electronic Health Record experience Proficiency in  QAPI systems

Job Description: Case Manager (RN) Case Manager (RN) Location: Palm Beach Gardens, FL Salary: $38-$42 per hour Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U991220       About the Opportunity A healthcare facility in Palm Beach, FL, has an excellent opportunity for an experienced Case Manager (RN) to join their staff in a full-time role. As a Case Manager, the qualified candidate will be responsible for ensuring that patients are provided optimal healthcare. The Case Manager assumes a leadership role with the interdisciplinary team to achieve optimal clinical outcomes. Company Description Healthcare Facility Job Description The Case Manager will: Coordinate the care of an assigned patient population during the acute care phase of illness from a utilization and discharge planning perspective Promote effective utilization of healthcare resources Participate in clinical information collection and process improvement Required Skills Florida State Registered Nurse license 2-3 years of acute care experience in hospital case management Some clinical review experience $

Job Description: Case Manager (RN) Case Manager (RN) Location: Worcester, MA Salary:  Experience: 3. year(s) Job Type: Temporary / Consulting Job ID: U1015000       About the Opportunity The Care Coordination Department of a recognized healthcare facility in Massachusetts is actively seeking a licensed Registered Nurse (RN) for a promising Case Manager position with their growing medical staff. In this role, the Case Manager (RN) will be responsible for identifying individual patient needs and developing plans of care as well as engaging and integrating appropriate resources for optimal clinical and financial patient outcomes. Apply today! Company Description Healthcare Facility Job Description The Case Manager (RN) will: Perform assessment of patient's physical, functional, and psycho-social needs through the use of screening tools, direct patient and family communication, medical record review, and discussions with other care givers providing services to the patient Performs admission and concurrent reviews, as assigned Collaboratively facilitates the care of patients throughout the continuum of care Works with patients and families to establish objectives, goals and an action plan to meet the patient's individual needs within the indicated level of care Contact third party payer to clarify benefit eligibility, coverage, and available resources for patients Coordinate, implement, monitor and evaluate outcomes of the discharge plan Continually evaluate the patient's level of care Educate the patient, family and care team regarding resource options, facilitate decision making, initiate plans, and secure resources for the patient on an ongoing basis in complex cases Participates in quality improvement on a system level through identification of opportunities for improvement, collection and analysis of data, and participation in the development and application of revised processes Support departmental and medical center-wide performance improvement programs such as implementation and monitoring of clinical practice guidelines Required Skills 3+ years of Clinical experience in Case Management and/or Discharge Planning Bachelor's Degree in Nursing MA Registered Nurse (RN) license Solid assessment, clinical, and documentation skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively Desired Skills Utilization Management and Third Party Payer knowledge

Job Description: Managed Care Coordinator Managed Care Coordinator Location: Trenton, NJ Salary:  Experience: 1. year(s) Job Type: Temporary / Consulting Job ID: U1012012       About the Opportunity A New Jersey-based healthcare organization is actively seeking a new Managed Care Coordinator for a promising position with their growing staff. In this role, the Managed Care Coordinator will be responsible for supporting the Health Services and Utilization Management functions and acting as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Apply today! Company Description Healthcare Organization Job Description The Managed Care Coordinator will: Perform review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients Handle initial screening for pre-certification requests from Physicians / members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff Prepare, document and route cases in appropriate system for clinical review Initiate call backs and correspondence to members and providers to coordinate and clarify benefits Review professional medical / claim policy related issues or claims in pending status Required Skills 1+ year of related work experience High School Diploma Knowledge of Medical terminology Computer savvy Solid problem solving and time management skills Exceptional phone etiquette Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively Desired Skills 1+ year of experience in a Customer Service or Medical Support related position College Degree Knowledge of Managed Care principles Knowledge of contracts, enrollment, billing & claims coding/processing

Job Description: Managed Care Coordinator Managed Care Coordinator Location: Mount Laurel, NJ Salary:  Experience: 1.0 year(s) Job Type: Temporary / Consulting Job ID: U1011159       About the Opportunity A healthcare organization in New Jersey is looking to fill an immediate need with the addition of a new Managed Care Coordinator to their growing staff. In this role, the Managed Care Coordinator will be responsible for supporting the Health Services and Utilization Management functions and acting as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Apply today! Company Description Healthcare Organization Job Description The Managed Care Coordinator will be responsible for: Performing review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients Handling initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff Preparing, documenting and routing cases in appropriate system for clinical review Initiating call backs and correspondence to members and providers to coordinate and clarify benefits Reviewing professional medical/claim policy related issues or claims in pending status Required Skills 1+ year of related work experience High School Diploma Knowledge of Medical terminology Computer savvy Solid problem solving and time management skills Exceptional phone etiquette Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively Desired Skills 1+ year of experience in a Customer Service or Medical Support related position College Degree Knowledge of Managed Care principles Knowledge of contracts, enrollment, billing & claims coding/processing

Job Description: Managed Care Coordinator Managed Care Coordinator Location: Trenton, NJ Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1005564       About the Opportunity A widely recognized healthcare organization in Trenton, NJ is actively seeking a driven and patient-oriented healthcare professional for a promising opportunity on their staff as a Managed Care Coordinator. In this role, the Managed Care Coordinator supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Company Description Healthcare Organization Job Description The Managed Care Coordinator: Performs review of service requests Handles initial screening for pre-certification requests from physicians/members  Prepares, documents and routes cases in appropriate system for clinical review Initiates call backs and correspondence to members and providers to coordinate and clarify benefits Initiates call back or correspondence to Physicians/Members  Reviews professional medical/claim policy related issues or claims in pending status Required Skills High School Diploma Polished and professional demeanor Ability to multitask Proficient in Microsoft Office Knowledge of medical terminology Strong verbal and written communication skills Demonstrated analytical skills Highly organized Desired Skills Bachelor's Degree 1-2 years of customer service or medical support-related experience Knowledge of contracts, enrollment, billing and claims coding/processing Knowledge of Managed Care principles Ability to analyze and resolve problems with minimal supervision Ability to use a personal computer and applicable software and systems

Job Description: Managed Care Coordinator Managed Care Coordinator Location: Ewing, NJ Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1005418       About the Opportunity A widely recognized healthcare organization located in Ewing, NJ is actively seeking a self-motivated and dynamic professional for a promising opportunity on their staff as a Managed Care Coordinator. In this role, the Managed Care Coordinator supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Company Description Healthcare Organization Job Description The Managed Care Coordinator: Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients Handles initial screening for pre-certification requests from physicians/members Prepare, document and route cases in appropriate system for clinical review Initiates call backs and correspondence to members and providers to coordinate and clarify benefits Upon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion Reviews professional medical/claim policy related issues or claims in pending status Upon collection of clinical and non-clinical information, authorize services based upon scripts or algorithms used for pre-review screening Perform other relevant tasks as assigned by Management Required Skills High School Diploma Strong medical skills and knowledge Proficient in Microsoft Office Excellent written and verbal communication skills Ability to make sound decisions under the direction of Supervisor Strong analytical skills Demonstrated interpersonal skills Team-oriented Desired Skills 1-2 years of experience in a customer service or medical support-related position Knowledge of contracts, enrollment, billing and claims coding/processing Knowledge of Managed Care principles Ability to analyze and resolve problems with minimal supervision Ability to use a personal computer and applicable software and systems

Job Description: Regulatory and Compliance Project Manager Regulatory and Compliance Project Manager Location: Bronx, NY Salary: $80,000-$100,000 Experience: 3.0 year(s) Job Type: Full-Time Job ID: J136365       About the Opportunity A healthcare facility in New York City is actively seeking an experienced Project Manager to focus on Regulatory and Compliance functions for the the facility. In this role, the Regulatory and Compliance Project Manager will be responsible for managing all aspects of regulatory reporting and data submission for various lines of business, including MLTC, FIDA, SNP and MAP. Apply today! Company Description Healthcare Facility Job Description The Regulatory and Compliance Project Manager will: Keep abreast of regulatory reporting, rules and changes; keep departments (including administrative, clinical and operations management) current and informed of issues Read, analyze and anticipate potential impact of proposed CMS/NYSDOH legislation, regulations and other guidance Identify and manage risk areas; present risk issues and items to senior management for review Support data collection, analyses, preparation and coordination of responses for regulatory audits, corrective action plans, quality/performance improvement plans Support compliance program activities Prepare and or update, for senior management approval, policies and procedures to comply with state and federal law and regulations; Prepare and handle the submission of marketing and participant materials for government approval; coordinate translations of marketing materials Organize and attend meetings related to programs and operations Required Skills 3+ years of related work experience Bachelor’s Degree in a related field Previous Compliance background Knowledgeable in Operations of MLTC, Medicare Advantage, FIDA and MAP programs Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized

Job Description: Regional Nurse Manager (RN) Regional Nurse Manager (RN) Location: New York, NY Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1010846       About the Opportunity A skilled nursing facility in New York City is currently seeking a licensed Registered Nurse (RN) to join their growing staff as a Regional Nurse Manager. Reporting to the Director of CHHA, the Regional Nurse Manager (RN) will be responsible for implementation and supervision of clinical programs and objectives of the CHHA's regional business operations. This is a great opportunity for a diligent and dedicated Regional Nurse Manager (RN) to gain valuable work experience and further their career at one of the facilities in Manhattan or the Bronx. Apply today! Company Description Skilled Nursing Facility Job Description The Regional Nurse Manager (RN) will: Manage and coordinate patient services Coordinate orientation and participate in the development of all levels of staff Identify needs and/or participate in formal and informal in-service activities for all levels of staff Utilize reports and other management tools to manage staff and build accountability Appraise job performance of nursing staff and team liaison in according to their job descriptions Maintain professional competency through participation in independent intra or extra-agency learning experiences Assist Business Development staff and facility discharge planners, Physicians, patients' family members, and other agencies to determine patient's eligibility to receive home health care services Manage clinical staff's daily productivity to ensure staff meets targets Manage workflows successfully by ensuring all clinical documentation and appropriate processes are followed to meet claims and billing requirements to meet accounts receivable goals Required Skills 2+ years of experience as a Public Health Nurse BSN NYS Registered Nurse (RN) license Previous Management experience Solid assessment, clinical, and documentation skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively Desired Skills MSN

Job Description: IVF Care Manager (RN) IVF Care Manager (RN) Location: White Plains, NY Salary: $80,000-$92,000 Experience: 2.0 year(s) Job Type: Full-Time Job ID: J137268       About the Opportunity A healthcare organization in Westchester County is actively seeking a licensed Registered Nurse, with a strong IVF background, for a promising Care Manager position with their growing staff. Under the guidance of the Vice President of Clinical Services and Consulting Chief Medical Officer, the IVF Care Manager (RN) will be responsible for managing treatment plan utilization and care, reviewing clinical outcomes to determine appropriateness of care, and ensure the organization and contract obligations are met. Apply today! Company Description Healthcare Organization Job Description The IVF Care Manager (RN) will: Review medical treatments and approve care based on the organization’s medical and contract guidelines Review non-standard service outcomes and enter outcomes into the Authorization Tracking System (ATS) ensuring entry of all required information Review data entered into ATS by Customer Service Agents (CSA) to ensure accuracy and completeness Call patients to discuss care, clarify, augment and/or confirm accuracy of information received from providers to ensure appropriate care, as necessary Ensure providers are informed of patient needs, treatment modification, and/or progress when necessary or requested Handle complex clinical issues or questions and troubleshoot clinical problems for the CSA team Track ART trends, quality of care, protocols and pathways, denial and appeal service reviews, and state mandates to ensure organization’s protocols are continually improving to meet or exceed ASRM guidelines Utilize knowledge of ATS, contract obligations, infertility, and best business practices to provide superior service to clients Review benefit status based on customer plans and eligibility file information prior to authorization of services or administrative/benefit denials Required Skills 2+ years of experience in Assisted Reproductive Technology, including: General Infertility; IVF or Infertility Care Management; and/or, Women’s Health Associate's Degree in Nursing NYS Registered Nurse (RN) license Microsoft Office/Suite proficient Solid assessment, clinical, and documentation skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively Desired Skills Bachelor's Degree in Nursing Bilingual (English and Spanish)

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Business process improvement manager jobs play an important role in helping businesses improve quality and effectiveness. Working to optimize a company’s fundamental processes, business process improvement managers ultimately help the company achieve outcomes more efficiently—reducing costs, refining job functions or improving customer satisfaction.

In these positions, managers partner with other business leaders to organize a company’s business plans. Typical tasks include evaluating business processes and enhancing them to achieve organizational goals. You should also be able to analyze complex business situations, use data to find creative solutions to complex business problems and lead the team.

To qualify for business process improvement manager jobs, you will need at least a bachelor’s degree. Many organizations prefer an MBA with additional certifications, such as PMP and Six Sigma, so further education is recommended. Before stepping into a business process improvement manager role, you will need significant experience in various facets of business.

Looking for business process improvement manager positions in healthcare? Check out our open positions at ADVANCE Healthcare Jobs. You can sort jobs by title, location or employer, so no matter your preference you can find the perfect position for you. Get started today!