Managed Care Specialist

Summit; Lakeland (FL); On-site; USD 80,000 - 110,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Wellness plans

Parental leave

Adoption assistance

Tuition reimbursement

Paid time off

Job summary

Sci Summit Consulting, LLC is seeking an experienced case manager for our workers' compensation program. This role involves coordinating treatment plans, collaborating with healthcare providers, and managing complex cases to ensure quality outcomes.

We require a minimum of 10 years in case management or managed care, with a nursing background preferred. The position offers full-time employment across regional offices with on-site work four days per week and one remote day as needed.

Qualifications

• Bachelor's degree recommended but not required in Nursing or RN
• Minimum of 10 years of case management or managed care experience
• Advanced knowledge of managed care laws and regulations

Responsibilities

• Monitors, coordinates, and evaluates complex treatment plans of assigned claimants to provide appropriate, effective, and cost-efficient care.
• Coordinates with vendors and healthcare providers to facilitate the treatment process including assessing and reviewing complex treatment plans and care facilities to ensure they meet the necessary medical standards and guidelines.
• Leads case management activities, including detailed documentation, follow-ups, and in-depth reporting on claimant progress.
• Monitors and controls medical costs by ensuring treatments are necessary and cost-effective.
• Maintains clear and effective communication with claimants, healthcare providers, and cross-functional teams to enhance collaboration and outcomes.
• Identifies, addresses, and resolves any issues or disputes related to claimant treatment.
• 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.
• Great American's culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in-office days are Tuesday-Wednesday, with the fourth day determined by business needs.
• This role can be based at any of the three regional offices.

Skills

Case management

Managed care

Healthcare coordination

Communication

Education

Bachelor's degree in Nursing

Job description

Company

Sci Summit Consulting, LLC

Summit provides independent insurance agents and their clients with market-leading workers' comp insurance and elite customer service. We're growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic.

Our strength comes from a single-minded focus on workers' comp and a commitment to long-term customer relationships. Summit is who you turn to when you need a specialist who not only knows workers' comp but also gets to know your business and your priorities.

Our field team members are located in every state in which we operate.

Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best.

This position is not eligible for employment visa sponsorship. Applicants must be authorized to work in the United States without the need for current or future sponsorship.

Essential Job Functions And Responsibilities

• Monitors, coordinates, and evaluates complex treatment plans of assigned claimants to provide appropriate, effective, and cost-efficient care.
• Coordinates with vendors and healthcare providers to facilitate the treatment process including assessing and reviewing complex treatment plans and care facilities to ensure they meet the necessary medical standards and guidelines.
• Leads case management activities, including detailed documentation, follow-ups, and in-depth reporting on claimant progress.
• Monitors and controls medical costs by ensuring treatments are necessary and cost-effective.
• Maintains clear and effective communication with claimants, healthcare providers, and cross-functional teams to enhance collaboration and outcomes.
• Identifies, addresses, and resolves any issues or disputes related to claimant treatment.
• 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.
• Great American's culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in-office days are Tuesday-Thursday, with the fourth day determined by business needs.
• This role can be based at any of the three regional offices.

Job Requirements

Education: Bachelor's degree recommended but not required in Nursing or R.N. (Registered Nurse).

Experience: Generally, a minimum of 10 years of case management or managed care experience.

Scope of Job/Qualifications: Advanced knowledge of managed care laws and regulations. Advanced ability to identify and address nuanced details that may impact the effective management of a case. Demonstrated advanced proficiency in organizing and prioritizing caseloads, ensuring timely completion.

Company

Sci Summit Consulting, LLC

Benefits

We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.

Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at http://www.gaig.com/careers.

• Excludes seasonal employees and interns.