Senior Manager, Managed Care and Clinical Quality and Training

The Senior Manager, Managed Care and Clinical Quality and Training will lead the Managed Care organization in the development of the strategic direction of the medical curriculum and medical quality improvement program.

Provide leadership, supervision, and strategic direction of the Managed Care and Clinical QA and Medical Education teams.

* Direct comprehensive quality and training programs, ensuring regulatory compliance and operational excellence.

* Serve as a technical and business resource for managed care and clinical.

* Develop, implement, and lead development of nurse case management best practices and policy and procedures and curriculum design to drive improvement and optimal claim outcomes.

* Provide oversight and direction for disability specialists and ERTW strategy.

* Oversight of medical director program.

* Cross functional work with claims QA on initiatives, special studies, and calibrations.

* Participate in evaluating new and emerging technologies and treatments to determine possible incorporation into medical management program including evidence-based protocols and medical innovations

* Serve as the liaison with regulatory and accrediting agencies for managed care

* Participate in the effective selection, coaching, medical education and clinical development and continuous improvement areas of nurse case managers and clinical review nurses

* Manages project development/enhancements through coordination with WC operations

* Leads Communications for MC Quality and Educational Program updates

* Provide oversight and direction for vendor quality reviews

* Oversight and administration for medical and strategic roundtables

* Additional responsibilities as designated by the Head of Managed Care and Clinical

Required

Education & Licensing

* 7+ years in Nursing Quality or Training related experience OR equivalent experience

* 5+ years of direct clinical care OR case management

* 3+ years of experience managing direct care nurses

* Active unrestricted RN license in a state or territory of the United States required.

* Bachelor's degree in nursing (BSN) from accredited college or university

* Knowledge of Workers' Compensation laws and regulations

Preferred

Masters of Science in Nursing Administration or Masters in Business Administration

Skills & Knowledge

* Ability to manage a diverse team including clinical professionals in multiple locations

* 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 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

* Strong Analytic and interpretive skills

* Strong organizational skills

* Excellent interpersonal 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

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking

#AmTrust

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.