So, if you’re ready for an altogether different workplace experience, get to know the people who know workers’ comp. Apply today.

Essential Job Functions and Responsibilities

• Review medical treatment plans for complex claims referred by the managed care team, discuss claims management with treating physicians, and advise internal nurse case managers on appropriate actions.

• Respond to questions submitted by managed care

• Review external clinical guidelines and review and update internal guidelines and policies to meet specific objectives and improve claim outcomes.

• Ensure medical accuracy and quality by reviewing samples of peer reviews and independent medical exams. Comply with other internal Quality Assurance activities as required by URAC and other accrediting bodies.

• Provide oversight/review of clinical content for internal training programs. Facilitate and participate in new hire and on-going training of clinical personnel (MDs, RNs) when required.

• Explore and disseminate significant updates/changes in internal medical policies to claims managers and the managed care team. Evaluate decision support tools such as treatment guidelines and protocols to support Claims.

• Participate in and provide medical advice to internal steering committees with various missions as well as task forces relating to specific issues/problems.

• Serve as a medical resource for a variety of activities, including Legal, Loss Prevention, and Business Development.

• May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports.

• Performs other duties as assigned.

This position allows for a hybrid work environment as well as FT remote.