Vice President, PRIME (Bill Review and Managed Care)

Overview

Responsible for the development, integration and operation of all aspects of our medical cost containment program. The essential functions of the position will be to differentiate the PRIME program in the marketplace; manage Bill Review and the Nurse Case Managers including utilization review and case management functions.  Ensure compliance of MPN with our business partner, design, develop and conduct training programs on medical case management; provide technical expertise to the Case Managers, and resolve complex procedural and medical issues.

Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability.

What You'll Do

• Manage Bill Review and Managed Care units.
• Review and report on monthly financials for case management and bill review.
• Management liaison with Enlyte / Genex, Harbor Health, One Call.
• Review of medical management impact reports to all Managers and Account Executives.
• Maintain competitive intelligence on all PRIME fees.
• Develop pricing matrixes to determine revenue for PRIME.
• Complete analysis of fees with based on information from competitive intelligence.
• Review pricing on an annual basis to determine if increases are needed, and provide analysis to the field with notification to the clients.
• Monitor copy service vendors/contracts and negotiate fees.
• Collaborate with vendor partners to improve programs.
• Assist with Client proposals and workshops.
• Completion of request for proposals.
• Provide overview presentations to potential partner carriers/on-site client visits.
• Assist Account Executives in program education/client interface.
• Coordinate bill review comparisons for new clients. 
• Development of branding/differentiation and best practices.
• Initiate and develop innovative, quality alternatives to traditional treatment plans and patient care services.
• Review complex cases that are referred by case management or claims personnel to identify and resolve problems.
• Design, develop and conduct training programs.
• Ensure that all training manuals, Policy and Procedure Manuals and other departmental manuals used by clinical and non-clinical staff are current.
• Keep current with medical technology and corresponding updates to medical practices and procedures.
• Other duties as assigned.

What You'll Need

• Bachelor’s degree in Nursing and an active RN license required. 
• Minimum of ten (10) years’ experience in Case Management and/or Workers Compensation, which includes medical management, utilization review, bill review, care management and designing and conduction of medical training programs required.
• Minimum of five (5) years of Supervisory experience required.
• Certified Case Manager preferred.
• Excellent verbal and written communication skills.
• Must be available to travel as needed.
• Proficient in Microsoft Outlook, Excel, PowerPoint and Word.  Adept at accessing business data from the Internet when required.

What's in it For You?

To help you make the best decision for your personal growth, it’s important to us to share a glimpse of what we offer our top asset, our people:   

• Competitive base salary.   
• Generous 30 Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days.
• Health benefit options with you in mind; 5 affordable medical plan options with rates based on your salary, company paid HSA contribution with eligible HSA plan selection, 2 dental plan options offering orthodontia coverage and 3 cleanings per year, and 2 vision plan options.    
• Company match 401(k) plan – 50% up to 6%!   
• Support of your fitness wellness goals! We offer up to 75% off at over 11,000 gyms and fitness centers.    
• Opportunity to prioritize your mental health with 24/7 access to licensed therapists.   
• Pet benefits & discounts.    
• Access to our Employee-led Resource Groups (ERGs) that lend a voice to the variety of demographics represented throughout our company.

Compensation:

The target salary range for this position is $200,000.00 to $240,000.00 (US Dollar) annually. The actual salary will vary based on applicant’s education, experience, skills, and abilities, as well as internal equity and alignment with market data. The salary may also be adjusted based on applicant’s geographic location. Remote work environment flexibility but must be located in California and be willing to travel.

Grow, with us

Accretive is a collection of elite specialty and wholesale agencies supported by experienced industry leaders. Our expertise is broad, and our innovative culture runs deep. We value relationships above all else and consistently deliver best in class customized solutions and service you can trust.

Accretive is passionate about fueling our clients’ innovation and growth. That makes us the perfect place for creative, dynamic people who want to grow their career while helping businesses, families and people thrive.  We are proud to be one of the largest brokers in the country, but we’re even prouder of the honest, caring relationships that our employees build with our clients every day.

Working with us will give you the opportunity to do work that matters while you learn with us, advance with us, and most importantly, grow with us. Accretive is committed to embracing diversity, equity and inclusion to create a workplace that welcomes and thrives on the unique experiences, perspectives and contributions of all team members. Accretive is bringing the best people and most diverse talent forward to drive growth, innovate and think bigger! 

Salary : $200,000 - $240,000