Director, Managed Care Services and Vendor Management

📋 Description

• Design and execute medical management strategies for early intervention and RTW.
• Establish productivity, quality, and outcome KPIs tied to claims outcomes.
• Lead Managed Care Services team; promote CARE model; partner with adjusters.
• Oversee external medical management vendors (pharmacy, UR, case mgmt, IME, networks).
• Develop vendor strategy with SLAs/KPIs; monitor costs and turnaround times.
• Drive automation and analytics; integrate workflows into claims systems.

🎯 Requirements

• Bachelor’s degree in Business, Healthcare, or related field preferred.
• 5+ years in Workers’ Compensation medical management or claims/vendor oversight.
• 3+ years of management experience in healthcare/claims operations.
• Deep knowledge of WC medical delivery models, utilization controls, and regulations.
• Demonstrated success managing multi-state medical vendor relationships.
• CPCU, CWCP, CCM, ARM or similar designation a plus.

🎁 Benefits

• MEMIC is committed to nondiscrimination and equal opportunity.
• Inclusive recruitment with reasonable accommodations on request.
• Privacy Notice: https://www.memic.com/job-applicant-privacy-notice
• Benefits offerings: https://careers.memic.com/benefits