Confidential
Vice President, Bill Review & Managed Care
Confidential, Oakland, California, United States, 94601
Vice President, Bill Review & Managed Care
About the Company
Respected insurance brokerage & risk management consulting firm
Industry Insurance
Type Public Company
Founded 1927
Employees 10,001+
Categories
Insurance Risk Management Consulting & Professional Services Agents and Marketers Employee Benefits Group Insurance Consulting Management Consulting Financial Services
Specialties
insurance risk management and consulting
Business Classifications
B2B Enterprise
About the Role
The Company is seeking a Vice President for Bill Review and Managed Care. The successful candidate will be responsible for the development, integration, and operation of all aspects of the medical cost containment program. This includes differentiating the program in the marketplace, managing bill review and nurse case managers, ensuring compliance with business partners, and designing and conducting training programs on medical case management. The role also involves providing technical expertise to case managers, resolving complex issues, and maintaining competitive intelligence on program fees. The Vice President will be a key management liaison, assist with client proposals, and be involved in the development of branding and best practices.
Applicants must have a Bachelor's degree with a minimum of 10 years' experience in the claims line of business, including at least 5 years in claims management positions. A comprehensive knowledge of industry best practices and procedures is essential, as is an active California RN license. The ideal candidate will have over 15 years' of claims experience and relevant industry designations. The role requires strong communication, negotiation, and influence management skills, as well as the ability to make strategic decisions and manage high-impact projects. The candidate should be a strategic thinker, have a strong service orientation, and be adept at multitasking and working independently. Experience with RMIS systems and data mining is also a plus.
Travel Percent Less than 10%
Functions
Finance Medical Care/Hospital Administration
About the Company
Respected insurance brokerage & risk management consulting firm
Industry Insurance
Type Public Company
Founded 1927
Employees 10,001+
Categories
Insurance Risk Management Consulting & Professional Services Agents and Marketers Employee Benefits Group Insurance Consulting Management Consulting Financial Services
Specialties
insurance risk management and consulting
Business Classifications
B2B Enterprise
About the Role
The Company is seeking a Vice President for Bill Review and Managed Care. The successful candidate will be responsible for the development, integration, and operation of all aspects of the medical cost containment program. This includes differentiating the program in the marketplace, managing bill review and nurse case managers, ensuring compliance with business partners, and designing and conducting training programs on medical case management. The role also involves providing technical expertise to case managers, resolving complex issues, and maintaining competitive intelligence on program fees. The Vice President will be a key management liaison, assist with client proposals, and be involved in the development of branding and best practices.
Applicants must have a Bachelor's degree with a minimum of 10 years' experience in the claims line of business, including at least 5 years in claims management positions. A comprehensive knowledge of industry best practices and procedures is essential, as is an active California RN license. The ideal candidate will have over 15 years' of claims experience and relevant industry designations. The role requires strong communication, negotiation, and influence management skills, as well as the ability to make strategic decisions and manage high-impact projects. The candidate should be a strategic thinker, have a strong service orientation, and be adept at multitasking and working independently. Experience with RMIS systems and data mining is also a plus.
Travel Percent Less than 10%
Functions
Finance Medical Care/Hospital Administration