Senior Managed Care Leader - Workers' Comp

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

Benefits offered by this job

Medical, dental, and vision coverage

401(k) with company match

Paid time off and holidays

Job summary

Great American Insurance Group’s Republic Indemnity division seeks a Senior Managed Care Manager to lead the claims team in coordinating high‑quality, cost‑effective medical care for California and western states’ workers’ compensation claims.

The role combines team leadership with hands‑on clinical expertise, partnering with providers, vendors and claims professionals to improve care coordination, outcomes, and medical-cost management. Hybrid in-office/remote work available.

Qualifications

• Bachelor’s degree in healthcare management or nursing; RN licensure preferred.
• Minimum 14 years of case-management or managed-care experience, including 6 years in leadership.
• Advanced knowledge of MTUS, ODG Guidelines, formulary requirements, and regulatory requirements.
• Experience managing complex or catastrophic cases and guiding claims professionals.
• Experience with provider/vendor management, medical-cost containment, CPT coding, rehab services.
• Strong leadership, communication, negotiation, collaboration and problem-solving skills.

Responsibilities

• Lead and oversee managed care activities to ensure appropriate, effective, timely, and cost-efficient treatment.
• Provide clinical expertise on complex and catastrophic claims, including hospitalizations and transfers.
• Apply MTUS, ODG, formulary requirements and applicable regulations.
• Review treatment plans and medical-cost projections for appropriateness.
• Guide staff in evaluating treatment requests and UR requirements.
• Oversee Nurse Case Management including direction, documentation, and caseload prioritization.
• Negotiate with providers and facilities for cost-effective treatments and equipment.
• Monitor medical expenses and utilization to balance care and costs.

Skills

Leadership

Clinical expertise

Negotiation

Collaboration

Communication

Problem solving

Education

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

Job description

Great American Insurance Group’s Republic Indemnity division seeks a Senior Managed Care Manager to lead the claims team in coordinating high‑quality, cost‑effective medical care for California and western states’ workers’ compensation claims.

The role combines team leadership with hands‑on clinical expertise, partnering with providers, vendors and claims professionals to improve care coordination, outcomes, and medical-cost management. Hybrid in-office/remote work available.