5 jobs found

Director of Utilization Management Overall Purpose: The Director of Utilization Management is a Registered Nurse with a current, unrestricted license that will be responsible for Prior Authorization and Concurrent Review staff, collaboration with care management functions, and program oversight. Additionally, this position is responsible for health plan audits and CMS reporting over multiple health plans. This position is responsible for development and oversight of utilization management functions, staffing, and daily operations for multiple delegated managed care health plan contracts. A successful candidate will have the following experience and qualifications: Education and Experience: ? Bachelor's degree in Nursing in required. Master's degree in preferred. ? Minimum five years of clinical nursing experience, including a minimum of two years in a managed care/HMO organization, required. ? Minimum two years managerial experience over a managed care, medical management system required. ? Licensure: License / ability to obtain and current registration to practice as a Registered Professional Nurse in the states where the company has contracts. ? Experience in utilization management program set up, discharge planning, policy and procedure development for efficient programs, understanding of nationally recognized standards and guidelines (CMS and NCQA). ? Experience presenting program data to internal and external stakeholders. ? Experience with CMS Managed Care standards, execution, reporting and auditing. ? Experience in utilization management (UM) programs and concurrent review processes along with claims department collaborations. ? Experience applying medical management treatment guidelines and nationally recognized criteria, such as InterQual / McKesson, MCG, or other practical management guidelines required. ? Experience with standard operating procedure writing. ? Experience with internal and external audit processes. ? Knowledge of CMS Star Ratings and components. Essential Functions: ? Knowledge of Medicare Advantage insurance structure and value-based care. ? Collaborates with senior leadership in the development of department strategic goals and objectives to align with overall organizational goals and financial targets. Ensures program integration and implementation of Quality Improvement (QI) activities to ensure services provided meet the needs of the member. ? Works strategically to advance the company in the community and among health plan clients. Monitors metrics and staff performance to constantly meet or exceed all organizational targets. ? Ensures compliance with all Federal & State Regulations and Requirements and Corporate Policies related to care management; Special Needs Plans; prospective / concurrent / retrospective care processes. ? Experience with State and external accreditation, managed care audits and reviews required. ? Assist EVP of Population Health, as needed. ? Ability to work independently under limited direction. ? Proficient with computer and software programs (e.g.; Microsoft Word, Excel) and the Internet required. ? Ability to learn internal and third-party software systems. ALL's WELL is proud to be an Equal Opportunity Employer. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment qualified applicants with arrest and conviction records. 0-1 years

Company Details: Own what's next. Add your experience and insight to our business. Berkley Agribusiness works with ambitious agribusiness and food industry clients to help them own their futures. Our culture is built on the belief that everyone has the power to create the future they deserve. Every Berkley Agribusiness team member must have the courage to challenge the status quo, collaboratively working with our clients to find creative property and casualty insurance solutions that drive them to succeed. We depend on our ability to listen to our clients - and our experience to help them make fact-based decisions that help their businesses thrive. Berkley Agribusiness is part of the W. R. Berkley Corporation (WRBC). Founded in 1967, WRBC is one of the nation's premier commercial lines property casualty insurance providers. All member insurance companies are rated A+ (Superior) by A.M. Best Company, and carry Standard & Poor's Financial Rating of A+ (Strong). Learn more about how Berkley Agribusiness can help you Create Your Future at (url removed) Responsibilities: The AVP-Business Development is expected to create and perpetuate business opportunities through the management and growth of a national distribution network of agency & broker partners with defined Agribusiness and Food practice groups. This individual must have extensive experience in the insurance marketplace in addition to exuding strong leadership and underwriting acumen to effectively vet production opportunities. Additionally, the candidate must have successfully demonstrated the acumen to network with C-suite and executive leadership to establish strategic partnerships. Strategically expands market access in the niche markets of Commercial Agribusiness and Food. Implements and monitors an effective agency management system that supports the company's profit and production objectives. Facilitate profitable business growth by building strong professional working relationships with business partners in key decision-making roles. Analyzes competitive marketing data, market and industry research, loss ratios, mix of business, policy count, premium growth, hit ratios and business retention to identify territorial and agency needs. Develops and implements action plans that align with company growth and profitability strategies. Recognizes opportunities to penetrate new markets. Takes advantage of all critical opportunities to increase market share. Performs due diligence on potential new domestic and international markets including developing definition, entry strategy, identifying scope and capital costs. Leads and influences agencies through creation and execution of sales strategies that drive new sales, profit and retention. Identifies new distribution opportunities and recommends agency appointments, while increasing relevancy in existing agencies. Develops, implements and manages an agency appointment and onboarding process that results in quality representation of the company. Ensures that business partners are familiar with the company's initiatives, products, policies, procedures and services. Develops and tracks metrics and success criteria for all sales/marketing programs and activities holding business partners accountable to profitability, production and volume commitments. Ensures the Company follows through on commitments to business partners. Exemplifies collaboration, teamwork and unified goals when working with peer leaders in Underwriting, Risk Services and Claims to secure resources, vetting out business opportunities, securing accounts and delivering on value proposition of service. Leverages relationships with other W. R. Berkley Corporation companies to capitalize on business opportunities and efficiencies. Qualifications: Bachelor's degree from an accredited college or university with major course work in Insurance, Risk Management, Business Administration or related degree. A minimum of 10 years of progressively responsible experience in the property and casualty insurance industry. Individual must possess strong leadership and underwriting acumen. Ability to travel on a regular basis; lead people and get results through others; think ahead and plan over a 2-3 year time span; organize and manage multiple priorities; communicate effectively with all levels of the organization; attract, coach, and develop talent. Must possess problem analysis and problem resolution skills at both a strategic and functional level; strong customer orientation; and interpersonal and communication skills including presentation skills. Regularly and consistently demonstrates commitment to company values and guiding principles.

Company Description ISO, a Verisk business, has been a leading source of information about property/casualty insurance risk since 1971. For a broad spectrum of commercial and personal lines of insurance, ISO provides statistical, actuarial, underwriting, and claims information and analytics; compliance and fraud identification tools; policy language; information about specific locations; and technical services. ISO serves insurers, reinsurers, agents and brokers, insurance regulators, risk managers, and other participants in the property/casualty insurance marketplace. To learn more about ISO please visit us at: We are proud to be a part of the Verisk family of companies! At the heart of what we do is help clients manage risk. Verisk (Nasdaq: VRSK) provides data and insights to our customers in insurance, energy and the financial services markets so they can make faster and more informed decisions. Our global team uses AI, machine learning, automation, and other emerging technologies to collect and analyze billions of records. We provide advanced decision-support to prevent credit, lending, and cyber risks. In addition, we monitor and advise companies on complex global matters such as climate change, catastrophes, and geopolitical issues. But why we do our work is what sets us apart. It stems from a commitment to making the world better, safer and stronger. It's the reason Verisk is part of the UN Global Compact sustainability initiative. It's why we made a commitment to balancing 100 percent of our carbon emissions. It's the aim of our "returnship" program for experienced professionals rejoining the workforce after time away. And, it's what drives our annual Innovation Day, where we identify our next first-to-market innovations to solve our customers' problems. At its core, Verisk uses data to minimize risk and maximize value. But far bigger, is why we do what we do. At Verisk you can build an exciting career with meaningful work; create positive and lasting impact on business; and find the support, coaching, and training you need to advance your career. We have received the Great Place to Work® Certification for the fifth consecutive year. We've been recognized by Forbes as a World's Best Employer and a Best Employer for Women, testaments to our culture of engagement and the value we place on an inclusive and diverse workforce. Verisk's Statement on Racial Equity and Diversity supports our commitment to these values and affecting positive and lasting change in the communities where we live and work. Job Description We are looking for a strong administrative assistant to join our team in support of executives. The right candidate will bring experience with power point presentations, spreadsheets, databases and word processing software packages to generate correspondence, manage calendars and travel, and otherwise support executive work in ways that improve their productivity. Responsibilities Be the professional point of contact and gatekeeper for multiple executives according to their preferences Maintain calendars for CIO and SVP of Sales & Customer Engagements, determining priority meeting acceptances, identifying conflicts, ensuring timely responses and guarding executive work time and privacy according to individual preferences Schedule and coordinate meetings involving all stages of planning including logistics, vendors and materials Provide administrative support to various teams on an as-needed basis including to but not limited to helping with presentation materials, tracking attendance at events, etc Process and submit invoices for department Process, submit, and maintains SOWs and records for all new contractor engagements Update team staffing assignments in project portfolio management tool Manage distribution lists for the department Make travel arrangements (domestic and international) including booking flights, hotel accommodations, ground transportation and visa processing. Prepare itinerary for traveler with all the necessary travel information. Prepare, reconcile and track expense reporting and reimbursement via Concur Organizes and maintains files, orders supplies and distributes mail as required Assist with overflow, assistant back-up phone coverage and day-to-day tasks and provide support to senior executives as needed Continually update own capabilities, identifying how to free executives from administrative work Qualifications Skills and Knowledge High proficiency in Microsoft Office required. Word, Excel, and PowerPoint a must. Excellent planning, organizational, problem-solving and follow-up skills with the ability to effectively handle multiple priorities Able to work well under pressure in a fast-paced environment and exercise sound judgement and discretion. Effective interpersonal and listening skills, telephone etiquette, superior oral and written communication skills, proofreading skills and attention to detail Handling of detailed confidential information requires a display of professionalism, discretion, tact, and good judgement. Ability to work with pace, good humor and independence High level of motivation, integrity self-confidence and the ability to take initiative, collaborative team player with a proactive approach Experience 3-5 years experience in an administrative role supporting management roles. Bachelor's degree strongly desired but not required Prior experience submitting expenses and reviewing incoming correspondence / emails required. Concur experience desired Additional Information Verisk Analytics is an equal opportunity employer. All members of the Verisk Analytics family of companies are equal opportunity employers. We consider all qualified applicants for employment without regard to race, religion, color, national origin, citizenship, sex, gender identity and/or expression, sexual orientation, veteran's status, age or disability. Unsolicited resumes sent to Verisk, including unsolicited resumes sent to a Verisk business mailing address, fax machine or email address, or directly to Verisk employees, will be considered Verisk property. Verisk will NOT pay a fee for any placement resulting from the receipt of an unsolicited resume. Consumer Privacy Notice

Company, a global communications agency, is seeking a Government Contracts Manager with experience in managing various types of government contracts, including cost reimbursement contracts and GSA Schedule contracts, to join our Washington, DC office. This position provides a fantastic opportunity for an experienced Government Contracts Manager to manage a large, and active, and important DOD subcontract, renew and administer a GSA Schedule contract, and lead the government contracts program for Company. Responsibilities Manage government contracts registration, certification, and reporting requirements, including SAM and small business subcontracting reporting. Manage a large DOD IDIQ subcontract, that includes cost reimbursement task orders. Manage effective communications between Company and prime contractor, and Company and government. Work closely with financial team for financial reporting, contract pricing, and in responding to audits. Collaborate with company internal and external legal advisors, including identifying and updating them on legal and compliance matters. Work with program personnel to develop contracts, SOWs, respond to RFQs for task orders, and to negotiate and execute contracting documents, and to ensure contract compliance. Review RFQs awarded task orders for compliance with DOD subcontract and applicable regulations. Ensure compliance with all subcontract and task order reporting requirements by advising and coordinating with program personnel. Advise and support subcontract financial manager to ensure financial, cost accounting, and invoicing procedures compliant with DOD subcontract. Negotiate, draft, and manage lower tier subcontracts and vendor agreements, including ensuring compliant lower-tier subcontract award, terms, management, performance, and reporting. Report to company management on performance, including task order obligations, invoices and payment status, budget and cost to complete, and deliverable schedule and status. Advise and train colleagues on government contractual and regulatory requirements and ethics. Manage and prepare proposal submission and negotiation for GSA Schedule Contract. Growth Opportunities Expand contract management procedures and function to grow the government contracts business. Collaborate with business development colleagues to select and pursue new government contract business opportunities. Enhance quality of responses to government solicitations and subcontracting opportunities. Improve, streamline, and enhance the review, drafting and negotiation of customer and vendor agreements, including non-disclosure agreements, teaming agreements, and product and/or service agreements. Assist other Omnicom Public Relations Group agencies in developing their government contracts administration function. Qualifications 8-10 years of experience successfully managing government contracts, including cost reimbursement contracts. Experience with CAS-covered contracts, cost-plus or IDIQ, DoD contracts, and GSA contracts preferred. Bachelor's degree in contract management, business administration or related field. Government contracts certifications (CPCM, CFCM) preferred. US Citizenship and the ability to obtain a US Government security clearance. Extensive experience with government contracts "common body-of-knowledge" (i.e., FAR, DFARS, TINA). Up-to-date knowledge and depth in government contracts compliance and ethics requirements. Proven experience with government procurement processes from proposal preparation, through bid process, protest and claims, contract award, and administration to final close-out. Experience in subcontract negotiation and management. Proficiency in government contracts registration, certification, and reporting requirements, including SAM and small business subcontracting reporting. Demonstrated results-focused approach and commitment to going the extra mile for clients and FH team members. Energetic, self-starter and resourceful problem solver - gets things moving and keeps them on track. High attention to detail with the ability to prioritize, organize, and manage multiple ongoing activities. Prior successful collaboration with program managers and business executives in a rapidly changing business and legal environment Highly evolved interpersonal skills with the ability to negotiate diplomatically and effectively, and maintain composure and quality under deadlines in a fast-paced environment. A strong team orientation is critical based on the collaborative culture of the office and Company.