Senior Managed Care Leader – Hybrid (California)

Great American Insurance Group; Woodland (CA); Hybrid; USD 135,000 - 183,000; Full time

Benefits offered by this job

Health insurance

401(k) plan with company match

Paid holidays

Job summary

Republic Indemnity Company of America in Woodland Hills, CA is seeking a Senior Managed Care Manager. The role combines clinical leadership with hands-on management of complex workers’ compensation claims, requiring expert knowledge of MTUS, ODG, and formulary rules.

The hybrid position emphasizes collaboration with claims professionals, providers, and vendors to improve outcomes and manage costs. The ideal candidate will bring extensive case-management experience, leadership skills, and a track

Qualifications

• Bachelor’s degree in Healthcare Management, Nursing, or related field.
• RN licensure preferred.
• 14+ years of case-management or managed-care experience, including at least 6 years in leadership.
• Advanced knowledge of California MTUS, ODG Guidelines, formulary requirements, and Utilization Review.

Responsibilities

• Lead and oversee managed care activities to ensure appropriate, effective, timely, and cost-efficient medical treatment.
• Provide clinical expertise on complex and catastrophic workers’ compensation claims and guide staff accordingly.
• Oversee Nurse Case Management activities and manage relationships with providers and vendors.
• Negotiate with providers, challenge excessive recommendations, and identify cost-effective alternatives.
• Monitor medical expenses and treatment utilization to balance care quality with cost control.
• Lead, coach, and develop staff and ensure compliance with regulatory requirements.

Skills

Leadership

Negotiation

Collaboration

Problem-solving

Education

Bachelor's degree in Healthcare Management, Nursing, or related field

RN licensure preferred

Job description

Republic Indemnity Company of America in Woodland Hills, CA is seeking a Senior Managed Care Manager. The role combines clinical leadership with hands-on management of complex workers’ compensation claims, requiring expert knowledge of MTUS, ODG, and formulary rules.

The hybrid position emphasizes collaboration with claims professionals, providers, and vendors to improve outcomes and manage costs. The ideal candidate will bring extensive case-management experience, leadership skills, and a track