Director of Managed Care

📋 Description

• Develop the overall business strategy, business plan, and phased launch roadmap for UR, MBR, NCM
• Establish the go-to-market and sales strategies, including integrated service offerings.
• Identify, develop, and secure initial clients among employers, insurers, third-party
• Design and implement the UR program, including policies, procedures, and documentation required
• Build the MBR service line, including fee schedule application, coding reviews, and appeals and
• Establish the NCM operating model, including clinical standards, caseload guidelines, pricing, and

🎯 Requirements

• Demonstrated senior leadership experience in managed care, preferably within the workers’
• Strong knowledge of Utilization Review, Medical Bill Review, Nurse Case Management, and provider
• Experience designing, launching, and scaling managed care programs, business units, or service
• Familiarity with California workers’ compensation regulations, UR program requirements, HCO
• Experience with URAC accreditation, clinical quality standards, regulatory compliance, and audit
• Proven ability to develop and execute business plans, go-to-market strategies, and revenue growth

🎁 Benefits

• Opportunity to build and lead a managed care division from the ground up.
• Director-level leadership position with significant strategic ownership and operational autonomy.
• Direct collaboration with the Chief Operating Officer and executive leadership team.
• Opportunity to shape business strategy, service offerings, organizational structure, and long-term
• Broad exposure to clinical operations, business development, technology implementation, and
• Opportunity to make a measurable impact on the workers’ compensation industry through integrated