AVP – Managed Care and Clinical

AmTrust Financial Services, Inc. Melville, NY
Overview

In order to improve healthcare quality and outcomes, leads the development and implementation of the Managed Care and Clinical business unit as part of the WC line of. As a new function, the position will require individuals in collaboration with others to set strategy, develop org structure, identify the roles and skills required and ensure the processes and policies are in place.

Responsibilities

* Work in partnership with the WC line of business lead to set the overall strategy for Managed Care and Clinical in support of workers' compensation claim administration

* Organizational planning and implementation of the managed care strategic, operational and service design inclusive of nurse case management, medical director and strategic partnerships

* Serve as the corporate leader for case management and integrated care coordination initiatives in accordance with state and regulatory requirements

* Direct and coordinate the planning, organizing, prioritizing, implementation and evaluation of the activities and associates engaged in care management

* Responsible for managing medical staff responsible for an assigned caseload to ensure individuals receive appropriate healthcare in order to return to work and normal activity in a timely and cost effective manner. Caseloads may include complex, catastrophic medical/disability cases and lost time.

* Develops and monitors lead and lag measures which serve to assess the effectiveness of case management processes

* Reviews and analyzes activities, costs and operations to determine progress toward stated goals and objectives

* Responsible for corporate care coordination policies and procedures. Continually reassess to ensure compliance with all State regulatory requirements, including State performance and reporting measures

* Proposes programmatic changes and innovative strategies to improve healthcare quality and outcomes based on assessment of current practices and professional clinical/operational skills

* Recommends plans for implementation of new/revised programs

* Develops and oversees HIT (health information technology) Systems that support the coordination of services and analysis of utilization

* Guides management team in selection of performance indicators/outcome measures

* Monitors departmental compliance to changing regulatory requirements at Federal and State level and insure that all indicators meet or exceed requirements

Qualifications

* 10+ years in a senior leadership role responsible Managed Care and Clinical in support of workers' compensation claims or a related field

* Experience with State and external accreditation managed care audits and reviews

* Strong verbal and written communication skills

* Advanced analytical skills

* 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 with leading company-wide initiatives a must, including ability to bridge across divisions and between Support Center and field teams.

* Experience applying medical management treatment guidelines, such as InterQual / McKesson, Milliman, or other practical management guidelines

* Experience with writing and implementing program level policy and procedures

Education

* MBA, Masters or related advanced degree preferred

* Knowledge and skills acquired through undergraduate studies in the areas of healthcare administration or related field

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Vacation and Holidays.

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