AVP Managed Care and Clinical

Assistant Vice President (AVP) Of Managed Care And Clinical

As the Assistant Vice President (AVP) of Managed Care and Clinical at AmTrust, you will be part of our Workers' Compensation Claims leadership team working alongside the Head of Managed Care and Clinical in setting the strategic direction and roadmap for cost containment, product development, and quality care. You will serve as the business lead for a team and in collaboration with other senior leaders, will lead improvement initiatives, and leverage technology solutions to include artificial intelligence. Strong analytical skills, use of data, modeling tools, medical cost containment solutions and products, as well as in-depth knowledge of trends impacting the Workers Compensation industry are required.

Responsibilities

Support Head of Managed Care and Clinical in leading the development and execution of the strategic plan to include identification of cost containment opportunities.

Serve as the business lead in the development and ongoing improvement of provider networks, product development, vendor partnerships, and cost strategy including workflows, process and key controls.

Contribute as a thought leader to identify new and innovative approaches in the use of technology, automation and new partnerships for improved loss outcomes and customer experience.

Work cross functionally in the design, implementation, and production of management reporting, KPIs, dashboards and analysis for optimal outcomes and identification of improvement opportunities.

Review and analyzes activities, costs, and operations to determine progress toward stated goals and objectives.

Ensure optimal use of resources.

Complete and present as needed executive level presentations, working cross functionally in support of required detail.

Monitor departmental compliance with changing regulatory requirements at Federal and State level and ensure that all indicators meet or exceed requirements.

Additional responsibilities as needed to assist and support Head of Managed Care and Clinical.

Qualifications

Strong analytical skills, use of data, modeling tools, medical cost containment solutions and products, as well as in-depth knowledge of trends impacting the Workers Compensation industry are required.

Demonstrated leadership to interact collaboratively and work effectively with a multi-functional team and throughout the organization; fosters an environment of shared responsibility and accountability.

10+ years in a senior leadership role responsible for Managed Care and Clinical in support of workers' compensation claims or related field.

Minimum 7-10 years of experience developing and fully operationalizing medical management programs with an emphasis on pharmacy and ancillary services. Experience in training, clinical applications, and clinical operations in workers' compensation.

Experience and demonstrated results to drive data-driven decision making, action plans, and executing key initiatives.

Ability to formulate business plans, operating budgets, and business cases in support of investments inclusive of benefit quantification and ROI.

Ability to interact collaboratively and work effectively with a multi-functional team and throughout the organization; fosters an environment of shared responsibility and accountability.

Experience with leading company-wide initiatives, including ability to bridge across divisions and between Support Center and field teams.

Proven ability to manage organizational change, to involve and influence others to accept new ideas or innovative approaches, to lead in a team-based organization.

Experience applying medical management treatment guidelines, such as InterQual / McKesson, Milliman, or other practical management guidelines.

Experience with writing and implementing program level policy and procedures.

Ability to develop reports, metrics, and improvement plans.

Excellent verbal and written communication skills.

Advanced analytical skills.

Ability to prepare presentation documents and present to senior leadership.

Advanced skills in Excel and PowerPoint.

Ability to manage a diverse team, including clinical professionals, in multiple locations.

Strong organizational skills.

Masters of Business Administration (MBA) required.

Clinical degree (RN, PharmD), in addition to MBA, preferred.

Ability to read and write SQL preferred.

Prior leadership experience.

Willingness to work extended hours when occasions demand.

Ability to travel up to 25% of the time.

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include : Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.