AVP Managed Care and Clinical

AmTrust Financial Services•Dallas, TX

10d

About The Position

As the Assistant Vice President (AVP) of Managed Care and Clinical at AmTrust, you will be part of our Workers’ Compensation Claims leadership team working alongside the Head of Managed Care and Clinical in setting the strategic direction and roadmap for cost containment, product development, and quality care. You will serve as the business lead for a team and in collaboration with other senior leaders, will lead improvement initiatives, and leverage technology solutions to include artificial intelligence. Strong analytical skills, use of data, modeling tools, medical cost containment solutions and products, as well as in-depth knowledge of trends impacting the Workers Compensation industry are required.

Requirements

Strong analytical skills, use of data, modeling tools, medical cost containment solutions and products, as well as in-depth knowledge of trends impacting the Workers Compensation industry are required.
Demonstrated leadership to interact collaboratively and work effectively with a multi-functional team and throughout the organization; fosters an environment of shared responsibility and accountability.
10+ years in a senior leadership role responsible for Managed Care and Clinical in support of workers’ compensation claims or related field.
Minimum 7-10 years of experience developing and fully operationalizing medical management programs with an emphasis on pharmacy and ancillary services. Experience in training, clinical applications, and clinical operations in workers’ compensation.
Experience and demonstrated results to drive data-driven decision making, action plans, and executing key initiatives
Ability to formulate business plans, operating budgets, and business cases in support of investments inclusive of benefit quantification and ROI
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, including ability to bridge across divisions and between Support Center and field teams.
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
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
Ability to develop reports, metrics, and improvement plans
Excellent verbal and written communication skills
Advanced analytical skills
Ability to prepare presentation documents and present to senior leadership
Advanced skills in Excel and PowerPoint
Ability to manage a diverse team, including clinical professionals, in multiple locations
Strong organizational skills
Masters of Business Administration (MBA) required
Ability to travel up to 25% of the time

Nice To Haves

Clinical degree (RN, PharmD), in addition to MBA, preferred
Ability to read and write SQL preferred
Prior leadership experience
Willingness to work extended hours when occasions demand

Responsibilities

Support Head of Managed Care and Clinical in leading the development and execution of the strategic plan to include identification of cost containment opportunities.
Serve as the business lead in the development and ongoing improvement of provider networks, product development, vendor partnerships, and cost strategy including workflows, process and key controls.
Contribute as a thought leader to identify new and innovative approaches in the use of technology, automation and new partnerships for improved loss outcomes and customer experience.
Work cross functionally in the design, implementation, and production of management reporting, KPIs, dashboards and analysis for optimal outcomes and identification of improvement opportunities.
Review and analyzes activities, costs, and operations to determine progress toward stated goals and objectives.
Ensure optimal use of resources.
Complete and present as needed executive level presentations, working cross functionally in support of required detail.
Monitor departmental compliance with changing regulatory requirements at Federal and State level and ensure that all indicators meet or exceed requirements.
Additional responsibilities as needed to assist and support Head of Managed Care and Clinical.