AVP Managed Care and Clinical

Overview

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.

• 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 analyze 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 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.
• 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 Inter Qual / 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.

Required:

• Masters of Business Administration (MBA) required.
• Clinical degree (RN, Pharm
  
  D), 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.

Salary range: $137,800-$185,000 annually. Salary information is a general guideline only; actual salary may vary based on skills, experience, education, and other factors.

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include:
Medical & Dental Plans, Life Insurance, Health Care Flexible Spending, Dependent Care, 401(k) 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…