Senior Manager, Managed Care and Clinical Quality and Training

The Senior Manager Managed Care and Clinical Quality and Training will lead the Managed Care organization in the development of the strategic direction of the medical curriculum and medical quality improvement program.

Provide leadership supervision and strategic direction of the Managed Care and Clinical QA and Medical Education teams.

Direct comprehensive quality and training programs ensuring regulatory compliance and operational excellence.

Serve as a technical and business resource for managed care and clinical.

Develop implement and lead development of nurse case management best practices and policy and procedures and curriculum design to drive improvement and optimal claim outcomes.

Provide oversight and direction for disability specialists and ERTW strategy.

Oversight of medical director program.

Cross functional work with claims QA on initiatives special studies and calibrations.

Participate in evaluating new and emerging technologies and treatments to determine possible incorporation into medical management program including evidence-based protocols and medical innovations

Serve as the liaison with regulatory and accrediting agencies for managed care

Participate in the effective selection coaching medical education and clinical development and continuous improvement areas of nurse case managers and clinical review nurses

Manages project development/enhancements through coordination with WC operations

Leads Communications for MC Quality and Educational Program updates

Provide oversight and direction for vendor quality reviews

Oversight and administration for medical and strategic roundtables

Additional responsibilities as designated by the Head of Managed Care and Clinical

Education & Licensing

7 years in Nursing Quality or Training related experience OR equivalent experience

5 years of direct clinical care OR case management

3 years of experience managing direct care nurses

Active unrestricted RN license in a state or territory of the United States required.

Bachelors degree in nursing (BSN) from accredited college or university

Knowledge of Workers Compensation laws and regulations

Preferred

Masters of Science in Nursing Administration or Masters in Business Administration

Skills & Knowledge

Ability to manage a diverse team including clinical professionals in multiple locations

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 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

Strong Analytic and interpretive skills

Strong organizational skills

Excellent interpersonal 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

#AmTrust

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.