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Directs the activities of Account Executives in building strong relationships with clients. Plans, organizes, implements, and evaluates outcomes of the department's strategic plans. Typically requires a college degree in marketing and experience in the health care industry and previous supervisory experience.: Develops strategic initiatives and transforms initiatives into action plans. Works with Account Executives to service custom client groups. Assists in the development and management of strategic accounts. Oversees preparation, coordination, and delivery of plan performance presentations. Identifies supporting strategies for product and program pricing, retention, and net revenue growth. Prepares and manages the departmental budget. Hires, develops, and motivates a qualified Account Executive staff and assesses employee ability to achieve desired performance levels.

Medical Management Director

Develops and implements a comprehensive and diversified marketing program related to systems and Medicare services. Directs the identification and evaluation of special studies relative to the development of new services and programs. Typically requires a college degree with four years of health service marketing experience. : Oversees and coordinates activities necessary to build and maintain strong, strategic relationships by proactively identifying and meeting service delivery needs. Conducts demographic and other marketing studies to identify trends to maximize effectiveness of marketing efforts. Researches targeted markets and evaluates marketing strategies to identify potential consumers of services. Recommends appropriate policies regarding pricing, promotion, product, and market evaluations and marketing plans. Prepares reports and analyses showing progress or adverse trends and presents appropriate recommendations or conclusions to management. Oversees hiring, developing, and managing a qualified staff concerned with Medicare marketing services and managing accounts. May assist in various special project such as cost feasibility studies for proposed or ongoing programs.

Quality Management Director

Directs and manages quality improvement, preventive health, and related departments of the health plan to identify levels and changes in the quality of medical care. Establishes protocols and serves as a resource regarding accreditation standards and continuous quality improvement principles. Designs, develops, and implements quality improvement initiatives necessary for attaining NCQA accreditation. Typically required to be a graduate of an accredited School of Nursing or a Registered Health Information Administrator (RHIA) with a minimum of four years of experience in direct patient care or in administration of health programs.: Develops and implements educational programs for practitioners and enrollees relative to quality improvement, preventive health, early and periodic screening, diagnosis and treatment, and credentialing. Assists in the development of clinical practice guidelines for use by providers. Oversees hiring, developing, and managing a qualified staff concerned with the evaluation of the quality of member care. Implements the organization's policies on quality standards. May work in conjunction with the Medical Director to assess opportunities for improvement and implement changes that will have a positive impact on medical outcomes and compliance with the plan's policies and contractual objections. Prepares and manages the departmental budget.

Management Engineering Director

Facilitates improvements in operating performance and competitive positioning in a health care environment through fundamental rethinking and redesign of core processes. Serves as primary link to the process improvement teams and natural working groups and implementation teams. Enables key stakeholders' participation and acceptance of change efforts. Directs a variety of management engineering projects and programs to provide management with statistical data in areas including information flow, cost containment, work standards, staffing levels, and productivity. Recommends procedure level standards for time and materials to be used by the Cost and Financial Management Systems staff and Hospital Departmental Managers.: Develops and implements studies of hospital functions and systems to include data collections and flow-charting. Prepares narrative and graphic displays of the studies' findings. Develops and directs varied feasibility studies related to the implementation of new ancillary procedures, clinic studies, and hospital processes from a cost and effectiveness standpoint. Develops and initiates a plan to educate departments on various topics related to productivity management and improvement strategies. Provides assistance to the Internal Audit Department in operational review of hospital departments. Researches and analyzes trends. Coordinates the preparation of reports setting forth progress, adverse trends, and appropriate recommendations or conclusions. Determines fiscal requirements and prepares budgetary recommendations. Directs various personnel functions including, but not limited to, hiring, training, promotion, transfer, and schedules.

Pricing Analyst

Compiles and analyzes statistical data to determine feasibility of buying products and to establish price objectives for contract transactions: compiles information from periodicals, catalogs, and other sources to keep informed on price trends and manufacturing processes. Obtains data for cost analysis studies by determining manufacturing costs within divisions of company. Confers with vendors and analyzes vendor's operations to determine factors that affect prices. Prepares reports, charts, and graphs of findings. Evaluates findings and makes recommendations to purchasing personnel regarding feasibility of manufacturing or buying needed products. May recommend use of alternative parts, materials, or manufacturing methods to reduce costs.

Case Management Manager

Oversees utilization management, care coordination, and discharge planning for patients. Assesses, plans, implements, monitors, and evaluates the services and options available to meet individuals' health needs, using screening criteria, developed critical pathways, and available resources to promote quality cost effective care outcomes. Supports the physician and interdisciplinary team in facilitating patient care in order to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. Identifies areas where performance improvement is needed, such as daily workflow, education, process improvements, and patient satisfaction.: Contributes to profitability and growth through expansion activities in case management (CM) care management. Assists in the development strategy with implementation of strategic, high quality, CM care management customer-specific products. Assists in the development of short- and long-term case management strategies, objectives, and budgets. Serves as resource for other departments in solving problems relating to patients, physicians, providers, payers, vendors, and accounts. Assists in development of and implements departmental and company policies and procedures. Conducts analysis of quality and productivity auditing of staff and departmental workflows. Directly manages licensed staff in CM Department, including interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; and addressing complaints and resolving problems. Assists the Director in the development and management of the CM Department budget, including monitoring overtime and associated costs, submitting purchase orders for departmental supplies, recommending additional staff, and assisting with purchases and capital expenditures requiring higher level authorization.

Health Data Analysis Director

Directs the development of health data strategic plans, policies, and procedures for utilization and cost containment information. Leads the analysis, preparation, and presentation of outcomes using healthcare claims data, pharmacy data, and lab data.: Manages the development of data reports and/or products that will enhance the retention of current market share and attract new business by demonstrating cost containment. Interacts with the MIS Department extensively. Interviews, selects, and trains employees. Plans and directs employees' work. Evaluates employees' productivity and efficiency and settles any complaints and grievances.

Case Management Supervisor

Supervises the daily operations of the case management function. Communicates with departmental and plan administrative staff to facilitate daily department functions. Assists with the implementation of policies and procedures regarding medical case management. : Facilitates the planning, monitoring, and implementation of care for patients. Coordinates case management activities with medical staff, data informatics, quality and utilization departments, etc. Evaluates patient outcomes and revises treatment plans as needed. Authorizes ancillary services, as needed, after approval by Physician. Ensures that client individual program plans comply and are consistent with client needs, laws, Federal and State regulations, contractual agreements, emergency management policies, and established referral, pre-certification, and authorization policies and procedures. Organizes and supervises liaison activities with community programs. Facilitates ongoing communication between case management staff, utilization management staff, and contracted providers. Acts as medical resource for appeals function. Conducts reviews of cases with doctors, hospitals, and other providers. Identifies trends and assists in financial forecasting. Trains, mentors, supervises, and evaluates case management staff.

Laundry Pricing Clerk

Computes cost of customers' laundry by pricing each item on customers' lists, using adding machine, calculating machine, or comptometer. May keep inventory of customers' laundered articles. May prepare statements to be sent to customers.

Program/Project Management Office (PMO) Manager

Determine and formulate policies and provide the overall direction of companies or private and public sector organizations within the guidelines set up by a board of directors or similar governing body. Plan, direct, or coordinate operational activities at the highest level of management with the help of subordinate executives and staff managers.

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