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Managed Care Client Services Director CLAIM YOUR FUTURE AS A GREAT PERFORMER! Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and 'Claim Your Future.' PRIMARY PURPOSE: To provide managed care expertise to current and potential Company clients; to support business development, program management and operational teams in providing quality cost containment programs to clients; to implement custom client solutions designed to improve managed care product performance and operational workflows and increase revenue and client outcomes/satisfaction. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Provides managed care expertise in new/renewal sales presentations, program rounding, managed care program design, and client implementations.
- Participates in new client implementations, consulting with Managed Care Practice Leader and Managed Care Implementation Manager throughout the project plan and roll-out of program.
- Participates in client stewardship meetings developing required reporting to support managed care product savings outcomes and delivery of services, and presentation of new managed care products.
- Identifies required resources for managed care program support; assigns responsibilities to team participants; and provides oversight to ensure success.
- Facilitates regulatory requirements, included but not limited to provider panel posting development, CA MPN solution, and MCO filing documentation.
- Supports Program Management initiatives to meet client expectations, program customization, outcomes reporting, benchmarking/analytics, trending and scorecarding to increase revenue and meet client objectives.
- Negotiates changes to Managed Care client budgets, contract/addendums, model design, custom reporting, performance guarantees and client service instructions.
- Supports client relationships, builds executive relationships; supports internal relationships, client/company knowledge; and resolves major customer services issues as needed.
- Supports Managed Care Practice Leader in development of subject matter expertise and team bench strength for growth in the Managed Care team.
- Develops and presents Managed Care product training components.
- Supports the total performance management initiative.
- Travels as required
SUPERVISORY RESPONSIBILITIES - Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
- Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
- Provides support, guidance, leadership and motivation to promote maximum performance.
QUALIFICATIONS Education & Licensing
Baccalaureate degree from an accredited college or university preferred. Experience
Seven (7) years Managed Care experience in insurance industry and two (2) years supervisory experience required. Claims management experience preferred. Experience in training development and presentation preferred. Skills & Knowledge - Thorough knowledge of Managed Care procedures and processes
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Leadership/management/motivational skills
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal and relationship-building skills
- Excellent negotiation skills
- Good judgment and discretion skills
- Ability to manage multiple projects and set priorities
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick CMS is an Equal Opportunity Employer and a Drug-Free Workplace
Client facing, services implementation program management type role. Insurance Claims industry experience a must.
Work location open to any Sedgwick office in the central US.
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