Director Medical Case Manager - Western Zone

About the role

AmTrust Financial Services, Inc., a fast-growing commercial insurance company, is seeking a Director of Managed Care and Clinical for its Western Zone. Reporting to the Head of Managed Care and Clinical, the Director will manage the performance, productivity, and medical management outcomes of managed care operations.

Responsibilities

• Oversee telephonic nurse case management, pharmacy management nurses, and utilization review nurses to support optimal claim results.
• Provide leadership and guidance for field managed care operations in the assigned zone.
• Execute medical management strategy, analyze results, and create annual operational goals and objectives for claim handling operations.
• Plan, organize, and monitor daily managed care operations, and ensure processes and protocols are effectively executed.
• Serve as a technical and business resource for nurse case management.
• Monitor and analyze legal developments and legislative changes that may affect medical management, collaborating with the Director of Medical Strategy and Clinical Optimization to address changes.
• Participate in the selection, coaching, medical education, and clinical development of nurse case managers.
• Manage project development and enhancements in coordination with WC operations.
• Use performance management and review processes to maximize employee performance, address performance problems, provide development opportunities, and promote effective communication.
• Ensure claim quality in accordance with best practices and company guidelines.
• Maintain appropriate staffing levels in conjunction with...

Requirements

The source describes the desired professional as hungry, humble, a strategic thinker, driven to deliver results, collaborative with authenticity and respect, and able to see the bigger picture.

Key facts

• The role reports to the Head of Managed Care and Clinical.
• The role oversees nurse case management, pharmacy management nurses, and utilization review nurses.
• The position is for AmTrust Financial Services, Inc.'s Western Zone.