Remote Managed Care Compliance Leader

Athens Administrators, Inc.; Nevada; Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical

Vision

Dental

Life and AD&D

Long Term Care

Critical Care

Accidental

Hospital Indemnity

HSA & FSA options

401k (and Roth)

Company‑Paid STD & LTD

Job summary

Athens Administrators, a nationwide family‑owned claims administrator, seeks a full‑time Managed Care Compliance Administrator to join the Managed Care team. This role can be remote if technical requirements are met and the employee resides in CA, AZ, CO, ID, NV, OK, TX, or OR.

Office hours are 7:30–5:30 local time, with a 9:00–17:00 PST schedule. The successful candidate will oversee audits, training, data analysis, and process improvement to ensure regulatory and quality compliance, while

Qualifications

• High School Diploma or GED or equivalent required.
• AA/AS or BA/BS preferred but not required.
• 5 years of utilization review, QA, case management or workers’ comp experience required.
• Fully versed in CA, AZ and TX workers’ comp laws; other states a plus.
• RN or LVN license preferred but not required.

Responsibilities

• Develop and maintain UR plan and best practices.
• Monitor day‑to‑day utilization review and nurse case management operations.
• Create department policies and workflows compliant with DWC standards.
• Oversee workflow of managed care services and cost containment strategies.
• Provide support to UR coordinators and NCMs for efficient operation.
• Train, supervise, and evaluate UR and NCM staff; verify licenses and CEUs.

Skills

Utilization review

Quality assurance

Case management

Professional communication

Training and supervision

Analytical skills

Critical thinking

Data analysis

Interpersonal skills

Education

High School Diploma or GED

AA/AS or BA/BS preferred

Job description

Athens Administrators, a nationwide family‑owned claims administrator, seeks a full‑time Managed Care Compliance Administrator to join the Managed Care team. This role can be remote if technical requirements are met and the employee resides in CA, AZ, CO, ID, NV, OK, TX, or OR.

Office hours are 7:30–5:30 local time, with a 9:00–17:00 PST schedule. The successful candidate will oversee audits, training, data analysis, and process improvement to ensure regulatory and quality compliance, while