Medical Management Manager.
- Career Level
- Not Specified
CopperPoint Insurance Companies is seeking a Medical Management Manager. The ideal candidate will be responsible for the daily management of company medical management staff, including nurses, who assist claim adjusters in the medical management of workers compensation claims. Continually assess medical trends, legislative and regulatory updates as well as current environment of Workers Compensation insurance to align and execute the organizations strategic and corporate initiatives.Responsibilities
- Execute and implement claims medical management guidelines and explore improved medical management and containment policies in support of the strategies and goals of the company; serve as consultant and provide expertise to claims employees. Participate in the maintenance of vendor relationships and maintain knowledge of products within the medical community, the companys consultative medical, chiropractic, dental and other provider advisors.
- Collaborate with the Claims leaders to impact appropriate balance between quality, cost, and delivery of service; develop and manage the systems for researching, measuring, evaluating, hiring and monitoring medical management and medical cost containment initiatives.
- Collaborate with leadership and claims adjusters to provide claim management consistency in approach, effectiveness, and ensure excellence in the practice and handling of claims.
- Knowledgeable expert on medical management programs to maximize process efficiency and balance costs with claims medical services, vendors and contracts.
- Provide medical management expertise for claims decisions, reserves, settlements and payments, either directly or by delegation.
- Provide direction and guidance in the design, development and delivery of claims technical training programs and compliance audit program.
- Oversee the revision, preparation and dissemination of new and updated technical reference resources to include procedure manuals, newsletters, job aids, and communication publications.
- Serve as leader for consistent practices, functional expertise and execution of nurse case management.
- Operational oversight for continuous improvement of medical management programs
BA or BS college degree required. The knowledge and skill levels acquired through undergraduate level studies from an accredited four-year college or university.
- Registered Nurse/RN, required.
- Ability to manage organizational change while maintaining a systematic perspective.
- Ability to make sound business decisions in complex matters with multiple stakeholders.
- Ability to analyze claims trends as well as evaluation of claims strategies for effective medical management control of medical costs.
- Analyze complex administrative problems, evaluating alternatives, and make creative recommendations.
- Previous successful work experience in providing leadership to and development of professional employees.
- Ability to interact collaboratively and work effectively with team and throughout the organization; fosters an environment of shared responsibility and accountability.
- Represent the team and Division effectively in meetings, including making presentations.
- Previous work experience with business analysis and metric skills to gather information.
- Working knowledge of Microsoft Office Suites and general PC.
About CopperPoint Insurance Companies:
Rated A- "Excellent" by A.M. Best, CopperPoint is Arizona's premier provider of workers compensation insurance. We promote a culture of workplace safety statewide via partnerships and training. In 2017, CopperPoint employees reported more than 5,500 hours of volunteer time. CopperPoint is a four-time winner of Best Places to Work in Phoenix.
CopperPoint is an equal employment opportunity employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic