Vice President, Bill Review and Managed Care

Gallagher•Torrance, CA

5d•Remote

About The Position

Keenan is a leading insurance brokerage and consulting firm serving hospitals, public agencies, and California school districts. Specializing in employee benefits, workers' compensation, loss control, financial services, and property & liability, Keenan is committed to delivering innovative solutions that protect and empower the communities we serve. As part of Gallagher, a global leader in insurance, risk management, and consulting, you’ll be joining a team that’s passionate about helping individuals and organizations thrive. The Vice President is responsible for the development, integration and operation of all aspects of our medical cost containment program. The essential functions of the position will be to differentiate the PRIME program in the marketplace; manage bill review and the nurse case managers including utilization review and case management functions. Ensure compliance of MPN with our business partner, design, develop and conduct training programs on medical case management; provide technical expertise to the Case Managers, and resolve complex procedural and medical issues. This is a remote position located in California. Must be willing to travel up to 25% throughout the state.

Requirements

Bachelors Degree with a minimum of 10 years experience in claims line of business required.
A minimum 5 years experience in claims management positions required.
Comprehensive knowledge of industry best practices and procedures.
Active California RN license required.

Nice To Haves

15 plus years claims experience highly preferred.
Relevant industry designations preferred.
Demonstrated verbal and written communications skills, negotiation skills and influence management skills.
Proven analytical and quantitative skills.
Strategic thinker; able to make prompt, intelligent decisions based upon detailed analysis of complex issues.
Strong service orientation to internal and external customers.
Excellent interpersonal skills.
Experience completing high impact projects effectively and efficiently.
Able to multitask and work independently.
Knowledge of Microsoft Office Suite tools.
Experience with RMIS systems and data mining.

Responsibilities

Manage Bill Review and Managed Care units.
Review and report on monthly financials for case management and bill review.
Management liaison with Enlyte / Genex, Harbor Health, One Call.
Review of medical management impact reports to all Mangers and Account Executives.
Maintain competitive intelligence on all PRIME fees.
Develop pricing matrixes to determine revenue for PRIME.
Complete analysis of fees with based on information from competitive intelligence.
Review pricing on an annual basis to determine if increases are needed, and provide analysis to the field with notification to the clients.
Monitor copy service vendors/contracts and negotiate fees.
Collaborate with vendor partners to improve programs.
Assist with Client proposals and workshops.
Completion of request for proposals.
Provide overview presentations to potential partner carriers/on-site client visits.
Assist Account Executives in program education/client interface.
Coordinate bill review comparisons for new clients. .
Development of branding/differentiation and best practices.
Initiate and develop innovative, quality alternatives to traditional treatment plans and patient care services.
Review complex cases that are referred by case management or claims personnel to identify and resolve problems.
Design, develop and conduct training programs.
Ensure that all training manuals, Policy and Procedure Manuals and other departmental manuals used by clinical and non-clinical staff are current.
Keep current with medical technology and corresponding updates to medical practices and procedures.
Other duties as assigned.

Benefits

Medical/dental/vision plans, which start from day one!
Life and accident insurance
401(K) and Roth options
Tax-advantaged accounts (HSA, FSA)
Educational expense reimbursement
Paid parental leave
Digital mental health services (Talkspace)
Flexible work hours (availability varies by office and job function)
Training programs
Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
Charitable matching gift program