Responsibilities:
-Director, Managed Care

• Sandy, UT, United States
• Full Time
• 10 paid holidays, 6% 401 k match, PTO, tuition reimbursement, and more

Position

The Claims Services department has an immediate opening for someone who can demonstrate the WCF values to join their team as a full-time Director, Managed Care. This posting is open to internal and external candidates and will work out of the Sandy, Utah headquarters.

Responsibilities

• Oversee the overall performance and outcomes of the managed care departments including Utilization Review, Medical Case Management, Vocational Rehabilitation, and Bill Review.
• Collaborate with internal stakeholders, such as claims management, underwriting, legal, and finance, to ensure effective coordination of managed care initiatives.
• Build and maintain relationships with external partners, including medical providers, pharmacy benefit managers, and other vendors.
• Develop and implement strategic initiatives to enhance our managed care programs, ensuring alignment with organizational goals and objectives.
• Leverage data analytics and industry best practices to optimize patient outcomes, reduce costs, and streamline processes.
• Collaborate with internal stakeholders, such as claims management, underwriting, legal, and finance, to ensure effective coordination of managed care initiatives.
• Build and maintain relationships with external partners, including medical providers, pharmacy benefit managers, and other vendors.
• Ensure compliance with all relevant state and federal regulations governing managed care programs, staying up to date on industry changes and implementing necessary adjustments to maintain compliance.
• Develop and track key performance indicators (KPIs) to evaluate the success of managed care programs.
• Provide regular reports and analysis to claims management, highlighting program performance, outcomes, and opportunities for improvement

Qualifications

The most qualified applicants will have:

• At least 6-8 years of experience in managed care, healthcare administration, or a similar role within the insurance industry.
• Strong knowledge of workers' compensation regulations, managed care principles, and medical treatment guidelines.
• Familiarity with utilization review processes, case management principles, and pharmacy benefit management is highly desirable.
• Proven experience in managing and leading cross-functional teams and departments.
• Excellent communication and interpersonal skills, with the ability to build and maintain relationships with internal and external stakeholders.
• Strong analytical and problem-solving abilities, with proficiency in data analysis and reporting.
• Demonstrated ability to drive process improvements and implement innovative solutions.
• Bachelor's degree in healthcare administration, business administration, or a related field. Master's degree preferred.

An internal candidate should have six months in their current position, acceptable job performance, and must notify their current supervisor that they've applied for the position.

INSURANCE DE&I MISSION

Promote and embrace a diverse, inclusive, equitable, and safe workplace.

INSURANCE IS AN EQUAL OPPORTUNITY EMPLOYER

Insurance provides equal employment opportunity to all qualified applicants and employees regardless of race, color, religion, sex, age, national origin, veteran status, disability that can be reasonably accommodated, or any other basis prohibited by federal, state, or local law.

Job Type: Full-time

Pay: $155,000.00 - $165,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience level:

• 6 years
• 7 years
• 8 years

Schedule:

• Monday to Friday

Work Location: In person