Senior Managed Care Leader - Hybrid (Remote/Onsite)

Republic Indemnity Company; Los Angeles (CA); Hybrid; USD 135,000 - 183,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Wellness plans

Parental leave

Tuition reimbursement

Paid time off and holidays

401(k) plan with company match

Employee stock purchase plan

Commuter benefits

Job summary

Republic Indemnity (RICA Republic Indemnity Company of America) seeks a Senior Managed Care Manager to lead clinical care management within the claims organization, combining leadership with hands-on expertise in complex workers’ compensation claims.

The role guides treatment plans, collaborates with providers and vendors, and ensures regulatory compliance while driving cost-effective outcomes. Hybrid in-office/remote work; on-site presence preferred in California.

Qualifications

• Bachelor’s degree in Healthcare Management, Nursing, or a related field required.
• Registered Nurse (R.N.) licensure preferred.
• Minimum of 14 years of case-management or managed-care experience, including at least 6 years in leadership.
• Advanced knowledge of MTUS, ODG Guidelines, formulary requirements, and regulatory standards.
• Experience managing complex or catastrophic cases and providing clinical guidance.
• Experience with provider/vendor management, medical-cost containment, CPT coding, and rehabilitation services.
• Demonstrated people-leadership experience including coaching and resource prioritization.

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.
• Apply MTUS, ODG Guidelines, formulary requirements, and regulatory standards.
• Review complex treatment plans and cost projections for clinical appropriateness.
• Guide staff in evaluating treatment requests for approval or referral to Utilization Review.
• Oversee Nurse Case Management activities and caseload prioritization.
• Negotiate with providers and facilities for cost-effective care.
• Collaborate with claimants, professionals, vendors, and teams to resolve issues and improve outcomes.
• Monitor medical expenses and utilization to balance care quality with costs.

Skills

Leadership

Clinical judgment

Negotiation

Collaboration

Problem-solving

Communication

Education

Bachelor’s degree in healthcare management or nursing

Job description

Republic Indemnity (RICA Republic Indemnity Company of America) seeks a Senior Managed Care Manager to lead clinical care management within the claims organization, combining leadership with hands-on expertise in complex workers’ compensation claims.

The role guides treatment plans, collaborates with providers and vendors, and ensures regulatory compliance while driving cost-effective outcomes. Hybrid in-office/remote work; on-site presence preferred in California.