Manager, Claims-Managed Care

Establishes and implements the domestic managed care strategy. Directs and manages the technical/medical aspects of the managed care services for the organization. Plans, develops, coordinates, and implements policies, procedures, and new case management programs for the managed care function. Develops strategic objectives for the medical case management services of the organization. Responsible for managing a network of providers including reporting and analysis to ensure quality and cost-effective medical management services.

Responsibilities

• Establish and implement the managed care strategy and direction for the medical case management services of the organization.
• Develop and manage resource and capacity models/plans to identify and align with customer demand, business financial objectives and overall business strategies.
• Provide strategic leadership for driving continuous improvement in operation by creating new processes, defining organizational efficiencies and delivery models and initiating change. Define and lead a culture of continuous improvement and best practices.
• Plans, develops, coordinates, and implements policies, procedures and new case management programs for the managed care function.
• Define, track and report on critical operational metrics that meet financial objectives for the business. Manage financial and operational process to meet overall cost objectives for the business.
• Develops and maintains strong working relationships with key customers and business partners.
• Creates and maintains effective communications across the managed care operation as well as the entire claims organization.

• Advanced knowledge of managed care, workers' compensation, quality improvement and medical cost management
• Demonstrated competencies in the areas of judgment, adaptability, collaboration, influence, drive for results, customer focus as well as attracting, developing and engaging talent
• Excellent written and verbal communication as well as exceptional critical thinking skills as normally required through a related bachelor?s degree and 10+ years of experience
• Master's degree preferred