Managed Care Specialist

The Managed Care Specialist is responsible and accountable for the outcome of clinical case management activities on behalf of the claims department.

- Manages complex workers compensation cases to ensure quality and clinical outcome is achieved through focused medical intervention.

- Acts as a technical medical resource to the claim staff

- Responsible for meeting legislative timeframes

- Manages the appropriate workflow processes within the Claim Department

- Develops and administers appropriate communication with the Claim Staff

- Interprets and manages medical intervention procedures

Qualifications:

Bachelor's degree (B.A.) from four-year college or university; or one to two-years related experience and/or training; or equivalent combination of education and experience. Requisite knowledge, skills and abilities:

to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations; to write reports, business correspondence, and procedure manuals; to effectively present information and respond to questions from groups of managers, clients, customers, and the general public; to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. To perform this job successfully, an individual must have knowledge of current recognized evidence based medicine guidelines, office operations, workflow analysis, and current technologies including Microsoft Office, applicable Claims databases, systems and vendor software programs. Licensed Vocational Nurse (LVN) certification required.