Director, Managed Care & Clinical Strategy

AmTrust Financial Services, Inc.; Scottsdale (AZ); On-site; USD 140,000 - 210,000; Full time

Job summary

AmTrust Financial Services, Inc. is seeking a Director of Managed Care and Clinical to lead the Western Zone’s medical management performance and outcomes. You will oversee telephonic nurse case management, pharmacy management nurses, and utilization review nurses to drive optimal claim results.

The role involves strategizing, coaching, and ensuring compliance with workers' compensation rules while developing a high-performing multi-location team across the zone.

Qualifications

• Active unrestricted RN license in the United States; BSN preferred.
• Bachelor’s degree in nursing or equivalent work experience.
• Certification in case management, pharmacy, rehabilitation nursing or related specialty preferred.
• Seven years of related experience; two years in direct clinical care OR two years in case management/utilization management.
• Five+ years of direct nurse management experience.

Responsibilities

• Provide leadership and guidance for field managed care operations in the assigned zone.
• Execute medical management strategy; analyze results and set annual goals for claim handling operations.
• Plan, organize, and monitor daily activities of managed care operations in the zone.
• Ensure all managed care processes and protocols are effectively executed.
• Lead nurse case management staff development and clinical education.

Skills

Nurse case management

Healthcare leadership

Regulatory compliance

Analytic thinking

Communication

Change management

Education

BSN (Bachelor of Science in Nursing)

Nursing degree

Tools

Microsoft Office

Job description

AmTrust Financial Services, Inc. is seeking a Director of Managed Care and Clinical to lead the Western Zone’s medical management performance and outcomes. You will oversee telephonic nurse case management, pharmacy management nurses, and utilization review nurses to drive optimal claim results.

The role involves strategizing, coaching, and ensuring compliance with workers' compensation rules while developing a high-performing multi-location team across the zone.