| |
| 1. | Do you wish to receive a FREE subscription to Workforce Management? |
Yes
No
Address type:
Business Address
Home Address
Vacation Address
I prefer not to receive direct mail correspondence from carefully screened third parties.
I prefer not to receive email correspondence from Workforce Management.
I prefer not to receive email correspondence from carefully screened third parties.
Yes, please auto-fill my contact information for other publication qualification forms.
| 2. | What is your position? (select only one) |
| 3. | What is your primary Business Industry? (select only one) |
| 4. | How many employees does your company employ? (Company Wide) (select only one) |
| 5. | What job functions do you perform? (select all that apply) |
| 6. | To verify your subscription, please enter the month in which you were born. |
| | Would you like to receive EMAIL notices of other print or online publications, and other relevant offers from TradePub.com? |
Yes
No
| | Sign up for special offer alerts from select partners featuring the latest products and services you are interested in. |
Yes
No
| Related FREE Offers from TradePub.com: Check those you wish to receive. |
| |
Job Function: |
|
| |
Industry: |
|
| |
What is the approximate number of employees in your company? |
|
| | Which of the following is closest to your job function? (select only one) |
| | What is the number of employees in your entire organization? (select only one) |
| | In addition to communications that may result from this inquiry, would you also like to receive news and event notifications from SAP that are specific to your interests? |
| |
Which of the following is closest to your job function? |
|
| |
What is the number of employees in your entire organization? |
|
| |
Is this your home address? |
| |
Yes |
| |
No |
| |
Advanstar Communications provides certain customer contact data (such as customers' names, addresses, phone numbers and email addresses) to third parties who wish to promote relevant products, services and other opportunities which may be of interest to you. If you do not want Advanstar Communications to make your contact information available to third parties for marketing purposes, simply call (toll free) 866-529-2922 at any time, or fax us at 218-740-6417. Outside the U.S., please phone 218-740-6395. Contact us by mail at Advanstar Communications Inc., 131 West First St., Duluth, MN 55802-2065, USA. |
| |
To permit future verification of your request, please answer ONE of the following questions: |
| |
Which of the following BEST describes the primary business of your organization or division? (select only one) |
| |
A. HEALTHCARE PLAN, PAYOR & ADMINISTRATIVE ORGANIZATIONS: |
| |
HMO/PPO/PSO/Insurance Company |
| |
Medicare/Medicaid/Governmental Plan |
| |
Supplemental/Carve-Out Insurance Plan (Dental/Vision/Behavioral Health) |
| |
Pharmacy Benefits Management (PBM) including Medicare Part D PDP |
| |
Third Party Administration (TPA) |
| |
Utilization Review Firm |
| |
Contract Management Firm |
| |
Group Purchasing Organization (GPO) |
| |
Employee Benefits Management (EBM) Firm/Consultant |
| |
Other Healthcare Plan, Payor & Administrative Organization |
| |
Please specify for Other: |
| |
B. HEALTHCARE PROVIDER ORGANIZATIONS: (An entity that directly treats patients) |
| |
Integrated Health Organization (IHO) (multi-hospital/practice settings; same ownership) |
| |
Integrated Delivery System (IDS) (multiple practice settings; same ownership) |
| |
Integrated Health Network (IHN) (multi-hospital; separate ownership) |
| |
Multi & Large Group Practice (50+ physicians) |
| |
Multi & Large Group Practice (less than 50 physicians) |
| |
Independent Hospital (300+ beds) |
| |
Independent Hospital (less than 300 beds) |
| |
Independent Practice Association (IPA) |
| |
Medical Clinic (50+ physicians) |
| |
Medical Clinic (less than 50 physicians) |
| |
Long-term Care Facility or Multi-Facility |
| |
Home Healthcare Organization |
| |
Other Healthcare Provider Organization |
| |
Please specify for Other: |
| |
C. INDEPENDENT CONSULTANT |
| |
D. NON-HEALTHCARE EMPLOYERS OF: (Aerospace, Automotive, Banking/Financing, Construction, Consumer Goods, Energy, Federal & State Government, Food/Grocery, IT–Hardware & Software, Retail) |
| |
5,000+ Employees |
| |
1,000 - 4,999 Employees |
| |
200-999 Employees |
| |
E. OTHER |
| |
Please specify for Other: |
| |
Which of the following titles & specialties BEST describes your highest current management position in the business organization selected in the above question? (select only one) |
| |
NON-CLINICAL EXECUTIVE: |
| |
Chief Executive: CEO/COO/President/Executive Director/Owner/Principal/VP/Director |
| |
Managed Care Executive: Chief/VP/Director |
| |
Administrative Executive: VP/Director |
| |
Financial Executive/Contracting Executive/Industry Relations Executive: CFO/VP/Director/Treasurer/Controller |
| |
Information Technology & Intelligence Services Executive: CIO/VP/Director (Software, Hardware, Web, Data Processing, Technology Assessment) |
| |
Medical Records Executive: VP/Director |
| |
Marketing Executive: CMO/VP/Director |
| |
Sales Executive: CSO/VP/Director |
| |
Patient Relations/Member Services Executive: VP/Director |
| |
Human Resources Executive: VP/Director |
| |
Employee Benefits Executive: VP/Director |
| |
Legal/Regulatory/Affairs Executive: Chief Counsel/VP/Director |
| |
Risk Management Executive: VP/Director |
| |
Other Non-Clinical Executive: VP/Director |
| |
Please specify for Other: |
| |
CLINICAL EXECUTIVE: |
| |
Medical Director |
| |
Chief of Medicine/Chief of Staff |
| |
VP/Director/Chief of Medical Affairs |
| |
Clinical Program Director/Services VP/Director (Specify: e.g., Oncology, Sports Medicine, Transplant, Disease, ER, Trauma, Wellness, Physical Therapy, Radiology, etc.) |
| |
Please specify: |
| |
Pharmacy/Formulary Director/Formulary Committee Chair |
| |
VP/Director/Chief of Pharmacy Services |
| |
Drug Information Officer/Clinical Pharmacist |
| |
VP/Director of Nursing/Chief of Nursing Affairs |
| |
Utilization Review/Quality Assurance VP/Director |
| |
Case Management VP/Director |
| |
Provider Relations VP/Director |
| |
Other Clinical Executive: VP/Director |
| |
Please specify for Other: |
| |
Total number of lives covered if at a Managed Care Plan/Payor Organization: |
|
| |
Tell us what you really think. Join Managed Healthcare Executive Research Panel today. |
|
 |
| | Security Check: Enter both words below, separated by a space. |
|
|