Managed Care Specialist

Summit Consulting•Lakeland, FL

9h•Hybrid

About The Position

Summit provides workers’ compensation programs and services to thousands of employers throughout the Southeast. Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it’s underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise. At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best.

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.
Viewed as a senior resource on the Managed Care team.
This job is non-exempt in California

Nice To Haves

R.N. (Registered Nurse) or L.P.N. (Licensed Practical Nurse) preferred.

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.