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Orange County, CA
(Click company name to view employer profile and all available positions.)
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| Career Field |
Claims
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| Insurance Discipline |
Property & Casualty
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| Relocation Assistance |
Not Available
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| Job Duration |
Full Time |
| Salary Offered |
Open
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Everest National Insurance Company, a member of Everest Re Group, Ltd., is actively seeking a Managed Care Manager for our Orange, CA office.
Position Purpose and Objectives :
Manage Everest’s key strategic alliances with our Managed Care vendors and Claim Service Providers (CSP). These vendors currently provide the following services on behalf of Everest:
1-800 Reporting of Injury lines
Telephonic/Field/Catastrophic nurse case management
Utilization Review/Peer Review
Medical Bill Review
Provider Networks
Return to Work Programs
Principle Duties Include :
Manage the California Medical Provider Network (MPN), Texas Health Care Network (HCN) and other state managed care networks as identified.
Monitor state regulatory/legislative changes pertaining to MPN, HCN, etc.
Work with Program Administrators, underwriters, agents and brokers and policyholders to improve the utilization and efficiency of the networks and related managed care services.
Other Essential Functions :
Assessment of workflows to maximize efficiencies and identify potential or actual delivery failure points.
Day-to-day communication with vendors to assure compliance with jurisdictional requirements and Everest’s Best Practices.
Conduct and analyze Quality Assurance reviews.
Manage and benchmark individual program results.
Maintain spreadsheet of existing open issues; track resolution.
Conduct routine reviews of managed care products currently utilized.
Manage implementation of new programs, including relevant vendor training.
Other as directed.
Performance Competencies :
Education & Licensing :
Bachelor’s Degree from an accredited college or university
Experience :
Five years plus workers’ compensation managed care experience.
Managing or supervising others.
Skills & Knowledge :
In depth knowledge of state workers’ compensation laws, including California SB 899 and Texas HB 7.
Bill review knowledge preferred.
Excellent oral & written skills.
Analytical & interpretive skills; excellent judgment, troubleshooting, problem solving skills.
Strong organizational skills.
Ability to work in a team environment.
Ability to handle multiple tasks and deadlines.
Through our competitive salary and bonus structure, as well as a diversified suite of benefits, we are committed to recruiting and retaining the most talented individuals in the industry. Our attractive array of benefits includes a 401k plan, pension plan, tuition reimbursement, medical, dental, vision, life and group legal plans.
Everest offers a dynamic work environment and a competitive compensation and benefit package.
We will contact only those candidates in whom we have a continuing interest. EOE/AA. Applicant must be a U.S. Citizen or Green Card Holder.
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