Managed Care Specialist

Summit Insurance Group, Inc.•Gainesville, GA

1d•Hybrid

About The Position

Summit provides independent insurance agents and their clients with market-leading workers’ comp insurance and elite customer service. We’re growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic. Our strength comes from a single-minded focus on workers’ comp and a commitment to long-term customer relationships. Summit is who you turn to when you need a specialist who not only knows workers’ comp but also gets to know your business and your priorities. Our field team members are located in every state in which we operate. Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best. It’s one thing to know workers’ comp. It’s another to know people. But knowing both? That creates an altogether different experience. So, if you’re ready for an altogether different workplace experience, get to know the people who know workers’ comp. Apply today.

Requirements

Bachelor’s degree in Healthcare Management, Nursing, or a related field.
Generally, a minimum of 10 years of case management or managed care experience.
Advanced knowledge of managed care laws and regulations.
Advanced ability to identify and address nuanced details that may impact the effective management of a case.
Demonstrated advanced proficiency in organizing and prioritizing caseloads, ensuring timely completion.
Excellent interpersonal and communication skills to collaborate with appropriate parties to ensure thorough and effective case management.
Stays informed about emerging legislation and industry standards.
Proven ability to handle confidential information with discretion.
Advanced analytical skills with the ability to use data to analyze complex situations, identify problems, and develop effective solutions.

Nice To Haves

R.N. (Registered Nurse) or L.P.N. (Licensed Practical Nurse) preferred.
Viewed as a senior resource on the Managed Care team.

Responsibilities

Monitors, coordinates, and evaluates complex treatment plans of assigned claimants to provide appropriate, effective, and cost-efficient care.
Coordinates with vendors and healthcare providers to facilitate the treatment process including assessing and reviewing complex treatment plans and care facilities to ensure they meet the necessary medical standards and guidelines.
Leads case management activities, including detailed documentation, follow-ups, and in-depth reporting on claimant progress.
Monitors and controls medical costs by ensuring treatments are necessary and cost-effective.
Maintains clear and effective communication with claimants, healthcare providers, and cross-functional teams to enhance collaboration and outcomes.
Identifies, addresses, and resolves any issues or disputes related to claimant treatment.
May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports.
Performs other duties as assigned.