Director, Managed Care Services – Vendor Management

🕒 July 14

🇺🇸 United States – Remote

💵 $150k - $175k / year

⏰ Full Time

🔴 Lead

🛒 Procurement

👻 Ghost score 20%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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MEMIC

WebsiteLinkedInAll Job Openings

201 - 500 employees

💼 Consulting

🏥 Healthcare

🛡️ Insurance

💰 $96M Series D on 2021-04

Consulting • Healthcare • Insurance

MEMIC is a company that provides workers' compensation insurance services. They focus on promoting workplace safety and offering comprehensive support for employers and workers. MEMIC offers various services such as injury reporting, claims management, and safety consulting. The company is committed to preventing fraud and providing educational resources and support through workshops and webinars. MEMIC aims to be a reliable partner in workplace safety and is involved in community outreach initiatives like safety campaigns. They offer various online services for managing insurance policies and claims efficiently.

📋 Description

• Design and execute medical management strategies supporting early intervention, injury triage, appropriate medical-service utilization, and timely return-to-work outcomes • Establish productivity, quality, and outcome-based performance expectations tied to claim outcomes • Manage and develop the Managed Care Services team and foster the C.A.R.E. model philosophy • Collaborate with Claims Adjusters and Claims leadership to improve claim resolution and medical management adoption • Oversee external medical management vendors, including pharmacy, ancillary, utilization review, case management, IME, peer review, medical bill review, and PPO/network partners • Develop and manage vendor strategy, including selection, onboarding, optimization, SLAs, and KPIs • Conduct vendor scorecards, audits, and business reviews; identify consolidation and capability-expansion opportunities • Support complex and high-exposure claims and serve as a clinical escalation point for challenging or litigated claims • Develop workflows integrating medical management into claims systems and processes • Drive medical spend reduction and improve outcomes, including reducing unnecessary treatment, opioid overutilization, and improving network utilization • Implement standardized workflows and lead automation, technology enablement, and continuous improvement initiatives • Manage departmental budget and evaluate ROI of medical management programs and vendor relationships • Support actuarial and finance teams with medical cost forecasting insights • Ensure alignment with state-specific Workers’ Compensation statutes and treatment guidelines such as ODG and ACOEM • Monitor and report medical severity, lost-time duration, return-to-work rates, cost per claim, trends, outliers, and intervention opportunities

🎯 Requirements

• Bachelor’s degree in Business, Healthcare Administration, Nursing, Risk Management, or related field preferred • Five or more years of progressive experience in Workers’ Compensation Medical Management, claims operations, or medical vendor oversight required • Three plus years of previous management experience required • Deep knowledge of Workers Compensation medical delivery models, utilization controls, and regulatory environments • Demonstrated success managing complex, multi-state medical vendor relationships • Strong analytical, financial, and negotiation skills • Clinical background (RN, CCM) or extensive experience partnering with clinical teams • CPCU, CWCP, CCM, ARM, or similar designation a plus • Experience supporting claims or medical transformation initiatives • Must not use AI or chatbot tools during the live interview or phone screen • MEMIC does not offer Stem-OPT EAD Extension for this role

🏖️ Benefits

• Benefit offerings are provided via the MEMIC benefits page; specific benefits are not listed in the posting