VP, Managed Care - Remote

Crum & Forster • Morristown, NJ

1d • $119,700 - $225,100 • Remote

About The Position

This individual will have primary responsibility for Workers’ Compensation vendor management with an emphasis on medical cost containment. In order to improve healthcare quality and outcomes, and promote loss cost containment, leads the development and continued implementation of the Managed Care Claim department as part of Workers’ Compensation Claims. This position works with the leader of the Workers’ Compensation line of business to set strategy for medical management, then executes improvement initiatives, leverages technology and AI solutions, as well as have responsibility for ongoing refinements to the business model inclusive of workflows, process and key performance indicators. Monitors compliance with changing regulatory requirements at Federal and State level ensure indicators meet or exceed requirements. Strong analytical skills, use of data, modeling tools and in-depth knowledge of trends impacting the Workers’ Compensation industry are required.

Requirements

• The qualified candidate will possess a bachelor’s degree or equivalent and 15+ years of experience.
• Minimum of 5 years’ experience in leading a Workers’ Compensation Managed Care operation.
• Extensive background in Workers’ Compensation and Managed Care within an insurance operation is required.
• Must have in depth knowledge of medical bill review processes and procedures in a full service environment.
• Must have strong knowledge of medical terminology and managed care operations, across multiple jurisdiction states.
• Ability to travel to other locations across the country as well as to our vendors is required.

Nice To Haves

• 5 plus years clinical experience preferred.

Responsibilities

• Responsible for establishing an infrastructure to support the negotiations, implementation and oversight with all contracted vendors.
• Vendor selection through Request for Proposal process, due diligence and contracting.
• Manage and audit vendors and develop strategies for improved processes and cost savings solutions with an emphasis on Workers’ Compensation medical management products and services.
• Oversee and maintain day-to-day operations of all managed care vendor programs, effectiveness and results.
• Develop metrics reporting from all vendors.
• Strong analytical skills to evaluate effectiveness of programs.
• Establish and maintain internal and external relationships and lead and high performing and goal-oriented team.
• Continuous development of product solutions to improve cost containment savings.
• Responsible for setting the vision and implementing strategies for creative cost containment initiatives.
• Business case development and full vetting of new products.
• Present business solution to Claims Executive staff and other key stakeholders.
• Regular communication to Claims Leadership and other stakeholders on results and areas of focus and improvement.
• Serve as liaison between vendors and claims staff.
• Develop, maintain, and manage a Managed Care Scorecard that encompasses all cost containment services.
• Audit, measure, report and evaluate all vendor’s performance.

Benefits

• Competitive compensation package
• Generous 401K employer match
• Employee Stock Purchase plan with employer matching
• Generous Paid Time Off
• Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family’s wellness, including your physical, mental and financial wellbeing
• A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path
• A dynamic, ambitious, fun and exciting work environment
• We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community
• At C&F you will BELONG

What This Job Offers

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