STAFF SERVICES MANAGER I

State of California•Sacramento, CA

37d•Remote

About The Position

Are you ready to join a high performing team who influences the delivery of superior treatment outcomes for injured employees? Are you passionate about helping others and doing the right thing? Do you desire to create a more positive customer experience? If the answer is YES and you believe you have what it takes, we would like to talk to you about joining the Claims Medical and Regulatory Division CMRD team! There are 3 openings, 1 in Medical Provider Network (MPN) Program Management unit, 1 in Ancillary Network unit, and 1 in Utilization Review unit. The Medical Provider Network Specialist is a resource and technical subject matter expert managing sensitive and complex projects while overseeing the operations for State Fund's MPN and medical management programs. The Medical Management Specialist is responsible for management of Utilization Review & Chronic Pain Programs and development of strategic programs. The Claims Operations Specialist is responsible for managing the ancillary network and development of programs/processes to enhance operational effectiveness. These positions may be filled in the following locations: Eureka, Vacaville, Riverside, Glendale, Redding, Rohnert Park, Pleasanton, Stockton, Fresno, Bakersfield, Santa Ana, San Diego or Sacramento. We are seeking an independent self-starter that is both analytical and creative and has the ability to drive for quality results on high-impact projects that align with the Division of Workers' Compensation regulations.

Requirements

5+ years of claims experience in California Workers Compensation
Have recent experience acting as a lead or participated as a team member on claims related projects
Developed and/or delivered claims training as a lead or a team member in the last 5 years
Effective written and verbal communication skills
Experience acting as a lead or mentor in your area of work
Proven track record of effectively collaborating cross-functionally
Experience working with and relating to customers with varying needs, to effectively resolve complex issues
Demonstrated ability to consistently meet or exceed goals and commitments
Project management or coordination experience
Excellent problem-solving skills to achieve best outcomes
Experience researching, analyzing, and interpreting laws/regulations, policies, and procedures to proactively make and implement recommendations and decisions
Experience performing Claims related audits
Willing to travel, which may include overnight travel

Responsibilities

Independently manage high profile projects from cradle to grave to improve medical management and cost containment
Conduct audits to ensure compliance with the regulations
Establish and maintain provider relations for the State Fund through an ongoing exchange of information and education among the medical community
Evaluate and resolving complex and sensitive State Fund's medical management programs issues
Manage vendor contracts to ensure compliance with service-level agreements and deliverables
Collaborate with Corporate Legal & Chief Medical Officer in creating and implementing medical management initiatives
Independently initiate studies to identify network trends and develop recommendations