Eastern Alliance is a 'best in class' specialty underwriter of casualty insurance with an emphasis on managed care worker's compensation products and services. Since 1997, Eastern has demonstrated a commitment to excellence and service to its agents, clients and their employees.
A key strategic leadership position currently exists for a Director of Medical Care Management (DMCM). This position is responsible for providing strategic and operational leadership that supports the Company's ecovery Injured Workers First business model and leads to better outcomes for our injured workers and insureds. This position also provides leadership and oversight, for the Medical Care Management (MCM) function and is responsible for establishing MCM goals, strategies and objectives to support the Company's strategic plan.
The DMCM is responsible for the effective management and organization of all units within the MCM function, including Medical Bill Review (MBR), Utilization Review (UR), Nurse Consultants, and Early Intervention. The DMCM will manage and implement programs with the goals of achieving excellent claims outcomes, reducing claims costs, and managing the impact of medical inflation while maximizing efficient utilization of resources. The DMCM is responsible for creating internal processes and protocols with audit oversight and working with strategic partners to ensure optimal outcomes while maintaining an acceptable cost structure and ensuring regulatory compliance.
As a member of the Eastern Family, you will enjoy a competitive salary with a full benefits package, a generous Paid Time Off program, 401K retirement savings with company match, and a work environment that supports your health and well being.
The minimum requirements for this position include a Bachelor's degree in Nursing, MBA, CPCU, CCM or other advanced degree or certification. Additional requirements include a minimum of 10 years of managed care or claim experience, preferably in workers' compensation; minimum of 5 years of management/supervisory experience; detailed knowledge and experience in medical care management and disability management; knowledge and understanding of medical bill review and provider networks; advanced analytical and problem-solving skills and excellent communication skills.