Vice President, PRIME (Bill Review and Managed Care)

Keenan & Associates • Torrance, CA

177d • $200,000 - $240,000 • Remote

About The Position

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. Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability.

Requirements

• Bachelor's degree in Nursing and an active RN license required.
• Minimum of ten (10) years' experience in Case Management and/or Workers Compensation, which includes medical management, utilization review, bill review, care management and designing and conduction of medical training programs required.
• Minimum of five (5) years of Supervisory experience required.
• Certified Case Manager preferred.
• Excellent verbal and written communication skills.
• Must be available to travel as needed.
• Proficient in Microsoft Outlook, Excel, PowerPoint and Word.
• Adept at accessing business data from the Internet when required.

Responsibilities

• Manage Bill Review and Managed Care units.
• Review and report on monthly financials for case management and bill review.
• Act as management liaison with Enlyte / Genex, Harbor Health, One Call.
• Review medical management impact reports to all Managers and Account Executives.
• Maintain competitive intelligence on all PRIME fees.
• Develop pricing matrixes to determine revenue for PRIME.
• Complete analysis of fees 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

• Competitive base salary.
• Generous 30+ Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days.
• Health benefit options with 5 affordable medical plan options, company paid HSA contribution, 2 dental plan options, and 2 vision plan options.
• Company match 401(k) plan - 50% up to 6%.
• Support of fitness wellness goals with up to 75% off at over 11,000 gyms and fitness centers.
• 24/7 access to licensed therapists for mental health support.
• Pet benefits & discounts.
• Access to Employee-led Resource Groups (ERGs).

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree