NashuaRecruiter Since 2001
the smart solution for Nashua jobs

Director of Managed Care and Clinical

Company: AmTrust
Location: Nashua
Posted on: October 13, 2020

Job Description:

Employer Name: SpiderID: Location: Nashua, New Hampshire Date Posted: 9/17/2020 Wage: Negotiable Category: Insurance Job Code: 2019-8834_0-2749 Job Description: Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Director of Managed Care and Clinical, in our Princeton New Jersey Office. PRIMARY PURPOSE: Reporting to the Head of Managed Care and Clinical, the Director of Managed Care will have responsibility for managing the performance, productivity, and medical management outcomes of AmTrust's managed care operations. This role will have oversight of telephonic nurse case management, pharmacy management nurses and Utilization review nurses to deliver optimal claim results. Responsibilities - Provide leadership and guidance for field managed care operations in assigned zone. - Execute medical management strategy; analyze medical management results and create annual operational goals and objectives for claim handling operation. - Plan, organize, and monitor the daily activities of managed care operations in assigned zone. - Ensure all Managed Care processes and protocols are effective executed. - Serve as a technical and business resource for nurse case management - Monitor and analyze significant legal developments and legislative changes that may affect medical management. Collaborate with Director of Medical Strategy and Clinical Optimization to address changes. - Participate in the effective selection, coaching, medical education and clinical development of nurse case managers. - Manages project development/enhancements through coordination with WC operations - Employ performance management and performance review processes to maximize performance of employees, correct performance problems, provide development opportunities and promote effective communication with employees. - Ensure claim quality in accordance with best practices and company guidelines. - Maintain appropriate staffing levels in conjunction with workloads. - Select, train and manage staff. Plan staff responsibilities and manage activities, utilizing staff resources effectively. - Ensure appropriate execution of quality assurance processes, inclusive of identification of strengths, deficiencies and implementation of action plans focused on improved results. - Lead by example in effectively supervising, coaching, developing, motivating, and evaluating staff. - Analyze and report on field claim activities and initiatives. - Ensure regulatory compliance with jurisdictional workers' compensation rules and statutes. Qualifications - Education & Licensing - Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license 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 (2) years of direct clinical care OR two (2) years of case management/utilization management required. - Five to seven 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 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. Job Criteria: Start Date: ASAP Position Type: Full-Time Permanent Years of Experience Required: Education Required: Overnight Travel: Vacation Time: Contact Information: Contact Name: AmTrust Company Type: Company: AmTrust City: State: Zip:

Keywords: AmTrust, Nashua , Director of Managed Care and Clinical, Healthcare , Nashua, New Hampshire

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


PCU Progressive Care Unit RN-Travel Nurse
Description: Travel Nurse Progressive Care RN Registered Nurse br PCU Travel Nurse Jobs Assignments br Looking for a PCU travel assignment You are in the right place, the HCEN Network of staffing agencies have (more...)
Company: RN Travel HealthCare Jobs
Location: Weymouth
Posted on: 10/26/2020

Travel Registered Respiratory Therapist (RRT)
Description: Respiratory Therapist RRT, CRT Locum Tenens Travel Assignments br Looking for that perfect Respiratory Therapist Job, this is the best resource. One quick More Info Request gets you in front of the (more...)
Company: Allied Health Travel Jobs
Location: Weymouth
Posted on: 10/26/2020

Child and Adolescent Psychiatrist Locums to Permanent Job in New Hampshire
Description: Psychiatric-Mental Health opening in Concord, New Hampshire. This and other physician jobs brought
Company: Jackson & Coker
Location: Concord
Posted on: 10/26/2020


Travel Cardiovascular Operating Room Nurse (CVOR RN), 12H Days 7:00 AM - 7:00 PM
Description: Travel Cardiovascular Operating Room Nurse CVOR RN Concord, NHLocation: - - - - - - - - -Concord, NHStart Date: - - - - - - -10/22/2020Shift Details: - - -12H Days 7:00 AM-7:00 PM - - - - - - - (more...)
Company: Triage Staffing
Location: Concord
Posted on: 10/26/2020

Internal Medicine Opportunity in Massachusetts
Description: Physician/MD qualifications required Internal Medicine - Excellent opportunity for
Company: Necnic Group, LLC
Location: Weymouth
Posted on: 10/26/2020

RN / Registered Nurse / New Hampshire / Any / Rehab Nursing Tech I PM Job
Description: Extra attention to detail Exceptional outcomes BE THE CONNECTION. Your role as a rehab nursing technician I lets you be the connection between dedication to detail and patient outcomes that exceed expectations. (more...)
Company: Encompass Health
Location: Concord
Posted on: 10/26/2020

Registered Nurse (Part Time)
Description: Walk-in Wednesdays On-site Interviews 10am-4pm every Wednesday - No appointment necessary Harris Hill Center 20 Maitland Street Concord, NH 03301 603 New Pay Wages Come Join Our Harris Hill Heroes (more...)
Company: Harris Hill Center - Genesis HealthCare
Location: Concord
Posted on: 10/26/2020

Home Instead Senior Care: Caregiver- Weekday Mornings
Description: At Home Instead of Central,
Company: Home Instead Senior Care
Location: Concord
Posted on: 10/26/2020

Operating Room Travel Nurse RN - $2196 weekly
Description: Nomad Health, the modern healthcare staffing company, seeks an experienced registered nurse for this rewarding travel assignment opportunity.Join
Company: Nomad Health
Location: Weymouth
Posted on: 10/26/2020

RN PACU Pre / Post Anesthesia - Travel Nurse
Description: Travel Nurses Needed - Surgical Services br Nationwide Travel RN Nursing JobsPACU Pre-Op / Post-Op Recovery RoomPost Anesthesia Care Unit Registerd Nurse br Post Anesthesia CareHCEN has numerous request (more...)
Company: RN Travel HealthCare Jobs
Location: East Providence
Posted on: 10/26/2020

Log In or Create An Account

Get the latest New Hampshire jobs by following @recnetNH on Twitter!

Nashua RSS job feeds