Senior Managed Care Manager

Republic Indemnity Company; Los Angeles (CA); Híbrido; USD 135 000 - 183 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

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

Resumo da oferta

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.

Qualificações

• 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.

Responsabilidades

• 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.

Conhecimentos

Leadership

Clinical judgment

Negotiation

Collaboration

Problem-solving

Communication

Formação académica

Bachelor’s degree in healthcare management or nursing

Descrição da oferta de emprego

Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group’s member companies are subsidiaries of American Financial Group. We combine a \"small company\" culture where your ideas will be heard with \"big company\" expertise to help you succeed. With over 35 specialty property and casualty operations, there are always opportunities here to learn and grow.

At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best.

For over 50 years, Republic Indemnity has been a trusted partner for businesses across the western U.S., helping them effectively manage their workers' compensation costs. Our headquarters in Woodland Hills, California, along with an additional office in San Francisco, to serve a hub for our operations. We specialize in workers' compensation in California and other western states, along with capabilities to support multistate accounts across the US.

Our Vision: Clear Paths to Success

At Republic, we believe in creating clear pathways for everyone - whether it's a broker, policyholder, injured worker, or colleague. We're committed to helping people reach their goals and achieve success.

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.

Division Overview

Republic Indemnity markets workers’ compensation insurance to a wide range of clients, primarily in California and the western United States. With a focus on strong results and exceptional service, we are committed to meeting the needs of our customers and delivering positive outcomes. Our employees play an important role in supporting that commitment and contributing to the success of the business. We offer ongoing opportunities to learn, grow, and build a rewarding career.

Position Overview

The Senior Managed Care Manager serves as a senior clinical resource to the claims organization, combining team leadership with hands-on expertise in managing complex workers’ compensation claims. This role oversees the coordination and evaluation of treatment plans to help ensure injured workers receive appropriate, effective, and cost-efficient care while guiding team members in applying clinical standards, regulatory requirements, and sound case-management practices. The position provides clinical direction for complex and catastrophic cases and partners with claims professionals, healthcare providers, and vendors to improve care coordination, claim outcomes, and medical-cost management.

Great American’s culture is built on connection, shared learning, and strong relationships. This is a hybrid role that combines in-office and remote work. Employees are expected to maintain a meaningful on-site presence to support collaboration, relationship building, and business success. Fully remote work will be considered based on the candidates location. The standard office hours are 8:00 a.m. to 4:30 p.m. PT.

Responsibilities

• Lead and oversee managed care activities to help ensure injured workers receive appropriate, effective, timely, and cost-efficient medical treatment.
• Provide clinical expertise on complex and catastrophic workers’ compensation claims, including hospitalization, transfers of care, traumatic brain injuries, and other severe conditions.
• Apply expertise in the California Medical Treatment Utilization Schedule (MTUS), ODG Guidelines, California formulary requirements, and applicable workers’ compensation medical treatment regulations.
• Review complex treatment plans, care facilities, and medical-cost projections to assess clinical appropriateness and alignment with applicable standards and guidelines.
• Guide staff in evaluating treatment requests for approval or referral to Utilization Review and support compliance with applicable Utilization Review requirements.
• Oversee Nurse Case Management activities, including clinical direction, documentation, follow-up, reporting, and caseload prioritization.
• Manage relationships with healthcare providers and medical vendors, including review of CPT coding, Letters of Agreement, durable medical equipment requests, and rehabilitation facility arrangements.
• Negotiate with providers and rehabilitation facilities, challenge excessive or unnecessary treatment and equipment recommendations, and identify clinically appropriate, cost-effective alternatives.
• Evaluate causation and body-part allegations and provide clinical guidance to support appropriate claims handling.
• Collaborate with claimants, claims professionals, healthcare providers, vendors, and cross-functional teams to resolve treatment issues and improve care coordination and claim outcomes.
• Monitor medical expenses and treatment utilization to identify opportunities for responsible cost management while maintaining appropriate standards of care.
• Lead, coach, and develop staff by establishing priorities, allocating resources, managing performance, supporting talent decisions, and helping the team achieve established goals.
• Monitor managed care laws and regulations, emerging legislation, medical trends, treatment strategies, and industry standards and translate relevant developments into practical team guidance.
• Participate in annual planning and goal setting and implement policies, procedures, and strategies under management direction.
• Perform other duties as assigned.

Qualifications

• Bachelor’s degree in Healthcare Management, Nursing, or a related field required; Registered Nurse (R.N.) licensure preferred.
• Generally, a minimum of 14 years of case-management or managed-care experience, including at least 6 years of leadership experience.
• Advanced knowledge of workers’ compensation clinical practices, including California MTUS, ODG Guidelines, formulary requirements, Utilization Review, and applicable medical treatment regulations.
• Demonstrated experience managing complex or catastrophic cases, evaluating treatment plans, and providing clinical guidance to claims professionals and case-management staff.
• Experience with provider and vendor management, medical-cost containment, treatment negotiations, CPT coding, durable medical equipment, rehabilitation services, and related contractual arrangements.
• Demonstrated people-leadership experience, including coaching and developing staff, prioritizing caseloads, allocating resources, managing performance, and leading two or more direct reports.
• Strong clinical judgment, communication, negotiation, collaboration, and problem-solving skills, with the ability to balance quality care, regulatory requirements, and responsible medical-cost management.

Company

RICA Republic Indemnity Company of America

Salary Range

$135,000.00 -$183,000.00

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.