Managed Care Specialist

Summit Insurance Group, Inc. • Gainesville, GA

4d • Hybrid

About The Position

Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. As the people who know workers’ comp, we strive to provide an atmosphere of constant growth and development for our employees. Summit provides workers’ compensation programs and services to thousands of employers throughout the Southeast. Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it’s underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise. At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. Essential Job Functions and Responsibilities Monitors, coordinates, and evaluates complex treatment plans of assigned claimants to provide appropriate, effective, and cost-efficient care. Coordinates with vendors and healthcare providers to facilitate the treatment process including assessing and reviewing complex treatment plans and care facilities to ensure they meet the necessary medical standards and guidelines. Leads case management activities, including detailed documentation, follow-ups, and in-depth reporting on claimant progress. Monitors and controls medical costs by ensuring treatments are necessary and cost-effective. Maintains clear and effective communication with claimants, healthcare providers, and cross-functional teams to enhance collaboration and outcomes. Identifies, addresses, and resolves any issues or disputes related to claimant treatment. May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports. Performs other duties as assigned. The person hired for this position will work out of the Gainesville, GA office which offers a hybrid work environment. (4 days in office, 1 day remote) #LI-Hybrid

Requirements

• Education: Bachelor’s degree in Healthcare Management, Nursing, or a related field.
• Experience: Generally, a minimum of 10 years of case management or managed care experience.
• Scope of Job/Qualifications: Advanced knowledge of managed care laws and regulations.
• Advanced ability to identify and address nuanced details that may impact the effective management of a case.
• Demonstrated advanced proficiency in organizing and prioritizing caseloads, ensuring timely completion.
• Excellent interpersonal and communication skills to collaborate with appropriate parties to ensure thorough and effective case management.
• Stays informed about emerging legislation and industry standards.
• Proven ability to handle confidential information with discretion.
• Advanced analytical skills with the ability to use data to analyze complex situations, identify problems, and develop effective solutions.
• Viewed as a senior resource on the Managed Care team.

Nice To Haves

• R.N. (Registered Nurse) or L.P.N. (Licensed Practical Nurse) preferred.

Responsibilities

• Monitors, coordinates, and evaluates complex treatment plans of assigned claimants to provide appropriate, effective, and cost-efficient care.
• Coordinates with vendors and healthcare providers to facilitate the treatment process including assessing and reviewing complex treatment plans and care facilities to ensure they meet the necessary medical standards and guidelines.
• Leads case management activities, including detailed documentation, follow-ups, and in-depth reporting on claimant progress.
• Monitors and controls medical costs by ensuring treatments are necessary and cost-effective.
• Maintains clear and effective communication with claimants, healthcare providers, and cross-functional teams to enhance collaboration and outcomes.
• Identifies, addresses, and resolves any issues or disputes related to claimant treatment.
• May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports.
• Performs other duties as assigned.

Benefits

• We offer competitive benefits packages for full-time and part-time employees.
• Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement.
• Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.
• Compensation varies by role, level, and location and is influenced by skills, experience, and business needs.
• Your recruiter will provide details about benefits and specific compensation ranges during the hiring process.
• Learn more at http://www.gaig.com/careers.
• Excludes seasonal employees and interns.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level