Managed Care Specialist

Location US-OH-Richfield
Posted Date 2 weeks ago(1/4/2021 4:52 PM)
Job ID
27113
# of Positions
1
Division
National Interstate
Category
Claims
Position Type
Full Time

Overview

National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you!

Responsibilities

• Monitors and facilitates each claimant's medical treatment to ensure appropriate, effective, cost-efficient, and quality care.
• Coordinates with vendors of rehabilitative services to ensure that services are consistent with the diagnosis and the goal of returning the claimant to employability and/or normal activities.
• Coordinates attendant care supervision, including the selection of appropriate care facilities. Assigns cases to vendors for utilization review.
• Provides professional advice and expertise to Claims staff in developing and providing medical and cost control procedures.
• Provides technical advice to lower level associates and other functional areas.
• Leads the work of others (mentors, prioritizes, delegates and reviews assignments).
• 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.

Qualifications

Education:
Bachelor's Degree or equivalent; R.N. (Registered Nurse) or L.P.N. (Licensed Practical Nurse) preferred.
Field of Study:
Business, Biology, Nursing or a related discipline.
Experience:
6 to 10 years of related experience, including Case Management experience.
Scope of Job:
Works within broad limits on highly complex assignments requiring specialized knowledge in breadth and/or depth within area of expertise. Viewed as a senior resource for the Claims department and/or organization. Next step in a traditional career progression would be to a management role. May be a team leader. Performs work under limited supervision. Typically has a defined specialty; monitors high severity/high complexity cases (i.e., severe burns, head and spinal injuries, etc.).


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