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Managed Care – Executive in Sarasota, FL at QuestPro Consultants

Date Posted: 11/21/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Sarasota, FL
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    11/21/2018

Job Description


Manager, Medical Management, UR & Provider Relations- Sarasota, FL


An A rated insurance carrier is actively seeking a manager to oversee their pharmacy benefit, utilization review and provider relations department.  The goal will be to provide excellent customer service in a timely manner to internal and external customers made up of medical and claims professionals focused on the worker's compensation managed care arena.  Preference will be given to candidates with exposures to workers' compensation, Medicare set-asides, and prior supervisory experience is a must.  Position is based in the office and relocation help is approved.  Apply today!




Qualifications

Required

  • Bachelor’s Degree (Nursing Preferred)
  • Minimum of six years of relevant medical management experience and two years in supervisory role
  • Medical Management Operations Management experience; (Insurance environment preferred)
  • Advanced knowledge of individual state medical bill processing requirements.
  • Advanced knowledge of Workers' Compensation Reimbursement Manual Guidelines.
  • Advanced working knowledge of utilization review/quality assurance policies and procedures.
  • Advanced knowledge of EDI processes for all state medical filings.
  • Intermediate knowledge of coding (ICD-10, CPT, Procedural) and medical terminology.
  • Intermediate knowledge of insurance forms and rules.

Preferred

  • Nursing experience and CMS/MSA experience
  • An active and current registered nurse license
  • Certification in at least two of the following: Life Care Planning (LCP), Medicare Set Aside Consultant Certified (MSCC), Certified Case Manager (CCM), Certification of Disability Management Specialist (CDMS), Certified Rehabilitation Registered Nurse (CRRN), or Certified Legal Nurse Consultant (CLNC)