AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Director of Medical Education and Quality in our Southington, CT or alternate location.

PRIMARY PURPOSE:

To support the Head of Managed Care and Clinical in the development of the strategic direction of the nurse case management program and medical curriculum as well as provide oversight of the nurse field staff.

• Leads development of nurse case management best practices and curriculum design
• Researches, analyzes and assists in development and driving of key initiatives for nurse case management to drive optimal claim outcomes
• Serve as a technical and business resource for nurse case management

• Responsible for the development and execution of the Medical Quality Improvement Program

• Participate in evaluating new and emerging technologies and treatments to determine possible incorporation into medical management program including evidence based protocols and medical innovations
• Direct/provide enhancements to business processes, policies and infrastructure to improve operational efficiency
• Serve as the liaison with regulatory and accrediting agencies for managed care
• Lead managed care and clinical operational reviews, strategic planning and budgeting
• Develop, implement and evaluate policies and procedures to meet business needs for nurse case management
• Participate in the effective selection, coaching, medical education and clinical development of nurse case managers.
• Manages project development/enhancements through coordination with WC operations
• Provide oversight and direction for vendor quality reviews and incorporate into Medical Quality Improvement Program
• Oversight of medical director program

Education & Licensing

Active unrestricted RN license in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.
Experience

Seven (7) years of related experience or equivalent combination of education and experience required to include two (5) years of direct clinical care OR two (5) years of case management/utilization management required.

Three (3) to five (5) years of direct nurse management experience.

Skills & Knowledge

• Knowledge of pharmaceuticals used to treat pain
• Knowledge of behavioral health
• Knowledge of pain management process
• Knowledge of drug rehabilitation process
• Knowledge of workers' compensation laws and regulations
• Excellent oral and written communication,
• Ability to prepare presentation documents and present to senior leadership
• Advanced computer skills to include Microsoft Products
• Proven ability to manage organizational change, to involve and influence others to accept new ideas or innovative approaches, to lead in a team based organization
• Ability to manage a diverse team including clinical professionals in multiple locations
• Ability to develop reports, metrics and improvement plans
• Ability to interact collaboratively and work effectively with a multi-functional team and throughout the organization; fosters an environment of shared responsibility and accountability
• Experience applying medical management treatment guidelines
• Experience with writing and implementing program level policy and procedures
• Analytic and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies
• Experience with State and external accreditation managed care audits and reviews
• Prior experience developing and leading nurse case management, medical director and clinical teams
• Demonstrated results in developing strategic plans and executing key initiatives
• Ability to collaborate across functional lines and leaders
• Strong communication and analytical skills

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

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.