Director of Group Health

🕒 3 dias atrás

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Dane Street

SiteLinkedInTodas as Vagas

51 - 200 funcionários

⚕️ Seguro de Saúde

📋 Conformidade

🏛️ Governo

Healthcare Insurance • Compliance • Government

A Dane Street é líder nacional em Exames e Revisões Médicas Independentes, fornecendo Exames Médicos Independentes (IMEs), Revisões por Pares e outros laudos médicos de forma objetiva, em conformidade e dentro dos prazos. Com uma ampla rede de mais de 16. 000 médicos, a empresa oferece serviços em 25. 000 localidades e 100 especialidades, incluindo sinistros de compensação trabalhista (Workers’ Compensation), automóvel, responsabilidade civil (Liability) e incapacidade (Disability). A Dane Street atende seguradoras, Third-Party Administrators (TPAs), organizações de Managed Care e órgãos federais/estaduais com análises médicas especializadas, ajudando-os a tomar decisões precisas. A empresa é reconhecida pela qualidade, prazos de entrega ágeis e processos eficientes, tendo conquistado credenciais como a Acreditação da NCQA em Utilization Management e a certificação Great Place to Work.

Descrição

• **JOB SUMMARY** • The Director of Group Health is responsible for the overall client satisfaction and growth of Dane Street’s Group Health Division. • Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results. • **MAJOR DUTIES & RESPONSIBILITIES** • - Ensure delivery of key client metrics including Turnaround Time (TAT), Quality (measured by clarification %), P2P success, overturn rate, and any other key performance metrics set forth by our Group Health customers. • - Lead the Operations Management Team and oversee all activities directly related to the operational procedures. • - Attract, recruit, and retain Team members. • - Work with the Group Health Operations Teams on internal and external quality audits and make recommendations on process improvements/updates. • - Recommend development initiatives to help enhance the usage of technology for client satisfaction and internal efficiencies. • - Responsible for the reconciliation of client outcomes reports & issue logs. • - Responsible for the overall Profit and Loss of the Group Health Division. • - Work with the National Medical Director on the development and management of the physician panel. • Other duties & special projects, as assigned and based on business needs.

🎯 Requisitos

• **EDUCATION/CREDENTIALS:** • A Bachelor’s or Graduate’s Degree is preferred. • **JOB RELEVANT EXPERIENCE:** • Minimum 5-10 years experience managing a team of Utilization Management (UM) Nurses at a Health plan or IRO. • RN (preferably BSN or higher) • Experience working with Utilization Management standards and guidelines • Experience leading an operational unit/division, ensuring customer service goals are met, and achieving profitability, goals and objectives. • **JOB RELATED SKILLS/COMPETENCIES:** • Present exceptional communication skills with a clear understanding of company business lines. The ability to apply critical thinking, manage time efficiently and meet specific deadlines. Computer literacy and typing skills are essential. • **WORKING CONDITIONS/PHYSICAL DEMANDS:** • Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work. • **WORK FROM HOME TECHNICAL REQUIREMENTS:** • Supply and support their own internet services. • Maintaining an uninterrupted internet connection is a requirement of all work from home position. • This job description is subject to change at any time.

🏖️ Benefícios

• Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace. • ABOUT DANE STREET: • A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.