Senior Manager Managed Care Regulatory Filings
Senior Manager Managed Care Regulatory Filings
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Job Description
Overview
AmTrust Financial Services a fastgrowing commercial insurance company has a need for a Manager Managed Care Filings in one of our offices in FL TX NY CA or IL.
PRIMARY PURPOSE: To support the Director of Utilization Review and Head of Managed Care and Clinical in the development and implementation of the internal Utilization Review program by completing all managed care and Utilization Review Organization filings in states throughout the country.
If you are local to one of our AmTrust locations this role would be hybrid.
Responsibilities
- Responsible for the and successful completion of AmTrust UR filings by state
- Maintain all standards for the URAC accreditation and responsible for any onsite or virtual validation reviews or audits.
- Monitor timeliness of UR determinations in daily/monthly reporting for compliance with jurisdictional requirements
- Research state Utilization Review regulations.
- Tracking and trending of treatment services processed in UR.
- Serve as the liaison with regulatory and accrediting agencies for managed care UR filings.
- Oversight of workflows to ensure process meets all state regulations.
- Maintain and coordinate all filings resubmissions and UR data calls as necessary.
- Assist in development and implementation of the Utilization Review program including jurisdictional research policies & procedures workflows vendor management and UR correspondence.
- Responsible for corporate responses to any UR complaints or questions from regulators in collaboration with Claim Legal Regulatory and Compliance departments
Qualifications
Education
College degree with major in Political Science Economics English Nursing or Philosophy
Previous experience in creating and submitting managed care and/or Utilization Review state filings is preferred
Moderate knowledge of Workers Compensation Utilization Review requirements by jurisdiction and accrediting bodies
Previous experience in maintaining URAC accreditation is preferred.
Experience in quality assurance and audits.
Experience in Paralegal research and submissions.
Skills & Knowledge
Utilization Review experience is required
Knowledge of workers compensation laws and regulations
Excellent oral and written communication
Advanced computer skills to include Microsoft Products
Advanced time management skills to maintain state filing schedule for resubmissions.
Ability to interact collaboratively and work effectively with a multifunctional team and throughout the organization
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
Ability to collaborate across functional lines and leaders
Strong communication 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 workrelated stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding Auditory/Visual: Hearing vision and talking
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#LIGH1
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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.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race ethnicity gender sexual orientation culture religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds skills and perspectives of its workforce it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative enabling us to attract retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company how we operate and how we see our future.
Required Experience:
Senior Manager
Employment Type
Full-Time
