Senior Manager, Managed Care Regulatory Filings
US
careers
Req #: 18235
Type: Regular Full-Time
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Overview: AmTrust Financial Services, a fast-growing commercial insurance company, has a need for a Manager, Managed Care Filings in one of our offices in FL, TX, NY, CA, or IL. PRIMARY PURPOSE: To support the Director of Utilization Review and Head of Managed Care and Clinical in the development and implementation of the internal Utilization Review program by completing all managed care and Utilization Review Organization filings in states throughout the country. If you are local to one of our AmTrust locations, this role would be hybrid. Responsibilities: * Responsible for the execution and successful completion of AmTrust UR filings by state * Maintain all standards for the URAC accreditation and responsible for any onsite or virtual validation reviews or audits. * Monitor timeliness of UR determinations in daily/monthly reporting for compliance with jurisdictional requirements * Research state Utilization Review regulations. * Tracking and trending of treatment services processed in UR. * Serve as the liaison with regulatory and accrediting agencies for managed care UR filings. * Oversight of workflows to ensure process meets all state regulations. * Maintain and coordinate all filings, resubmissions, and UR data calls as necessary. * Assist in development and implementation of the Utilization Review program including jurisdictional research, policies & procedures, workflows, vendor management and UR correspondence. * Responsible for corporate responses to any UR complaints or questions from regulators in collaboration with Claim Legal, Regulatory and Compliance departments Qualifications: * Education College degree with major in Political Science, Economics, English, Nursing or Philosophy Previous experience in creating and submitting managed care and/or Utilization Review state filings is preferred Moderate knowledge of Workers Compensation Utilization Review requirements by jurisdiction and accrediting bodies Previous experience in maintaining URAC accreditation is preferred. Experience in quality assurance and audits. Experience in Paralegal research and submissions. Skills & Knowledge Utilization Review experience is required Knowledge of workers' compensation laws and regulations Excellent oral and written communication, Advanced computer skills to include Microsoft Products Advanced time management skills to maintain state filing schedule for resubmissions. Ability to interact collaboratively and work effectively with a multi-functional team and throughout the organization Strong organizational skills Excellent interpersonal skills Excellent negotiation 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 Ability to collaborate across functional lines and leaders Strong communication 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 Auditory/Visual: Hearing, vision and talking #AmTrust #LI-GH1 #LI-HYBRID
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