Director of Managed Care
Core
Lead the creation and development of a new managed care division within the workers' compensation industry, overseeing four core service lines: Utilization Review, Medical Bill Review, Nurse Case Management, and Provider Networks.
Role type
Director of Managed Care (Strategic Leadership)
Builds
A new managed care division with scalable service models for employers, insurers, and self-insured organizations
Domain
Workers' Compensation / Managed Care
Required skills
Managed care leadership, Workers' compensation ecosystem knowledge, Business strategy and planning, Business development and sales, Regulatory compliance (California), Team building and leadership, Financial management (P&L), Provider network management, Utilization review operations, Medical bill review operations, Nurse case management operations, URAC accreditation experience
Preferred skills
Experience launching service lines from inception, Familiarity with HCO/MPN certification processes, Knowledge of managed care technology platforms
Technologies
Managed care technology platforms, Medical bill review systems, Provider network databases, Integrated reporting solutions
Responsibilities
Develop overall business strategy and phased launch roadmap for service lines, Establish go-to-market and sales strategies to secure initial clients, Design and implement Utilization Review programs and policies, Build Medical Bill Review service lines and fee schedule applications, Establish Nurse Case Management operating models and clinical standards, Lead Provider Network development including certification and credentialing, Develop compliance frameworks and risk management processes, Manage division startup budget and P&L performance, Recruit and develop multidisciplinary teams across service lines, Select and implement technology platforms to support operations
Seniority
Director, Strategic Leadership