Medical Services Manager
BHHC - Omaha, NE

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BASIC FUNCTION:
We have an opening in our Omaha, Nebraska office for a Medical Services Manager. The Medical Services Manager is responsible for the development, management, and performance of the Case Management Coordinators, external nurse case management vendors, and medical networks and panels.

ESSENTIAL RESPONSIBILITIES:
Manage the Company’s staff of Case Management Coordinators.

Ensure the Adjusting staff receives effective nursing support providing them with medical information and guidance that will help them manage, reserve, and settle claims effectively.
Ensure the Case Management Coordinators coordinate effectively with Utilization Review and Adjusting to facilitate effective, efficient medical treatment of injured workers.
Implement and manage a program of review and consultation to identify and help manage claims that meet defined medical criteria.

Manage the Company’s program of external, vended nurse case management services.

Develop, maintain, update, and continually improve a nationwide panel of efficient, high-quality nurse case management firms and manage the services provided by those firms.
Work with Adjusting to ensure that field case managers are assigned in appropriate claims in a timely manner, are given clear assignments, perform their work effectively and efficiently, and are removed from claims when their services are no longer required.
Develop and operate a program of nurse case management bill review.

Manage the Company’s program of medical networks and panels.

Establish and maintain networks and panels of medical providers to ensure injured workers receive effective, efficient treatment for compensable injuries.
Ensure that networks and panels operate in compliance with Company policy, certification standards, and applicable state and federal statutes and regulations.
Develop methods and criteria to identify high-quality providers through data analysis and other methods, and for entering and maintaining contractual relationships with them.
Manage Medicare set-asides, life care planning, and medical cost projections including managing internal staff, vended services, contracts, and the Company’s policies and strategies relating to these matters; ensure compliance with relevant legal requirements.
Maintain the highest level of expertise regarding workers compensation case management and medical networks and panels including data analysis, current issues, future development, best practices, contracting and contract management, certification standards, and legal requirements.
Ensure that the Medical Services operation functions as an efficient, high-quality internal service provider of medical support services.
Maintain patient confidentiality and safeguard protected health information in accordance with state and federal laws and Company policies.
Foster and guide the personal and professional development and growth of individual Medical Services employees to help them build successful and satisfying careers while producing excellent results in their work and exhibiting exemplary professional behavior.
Continually analyze data from vendors, providers, the industry, and the Company to increase the Company’s capacity to understand the effectiveness and efficiency of providers and treatment methods. Work in tandem with Company’s data analysts in creating and enhancing outcome measurements.
Foster a positive and close working relationship with other Company staff, including the adjusting staff, utilization review, medical bill review, special investigations, legal, lien resolution, the call center, and client services.
Assist in the creation of training programs relating to the medical aspects of claims management including purely medical topics as well as topics regarding nurse case management and medical networks and panels.
Advise senior management on initiatives, programs, policies, and standards relating to Medical Services.
Serve as a role model for the Company’s culture by embodying the highest standards of collaboration, leadership, performance, behavior, and ethical standards.

QUALIFICATIONS:
Experience, Education, and Certification: Bachelor of Science Nursing degree (BSN); or Registered Nursing degree (RN) with an active license is advantageous; or a bachelor’s or master’s degree in a field relating to the business of medicine – is advantageous but not mandatory. A strong background in the business of medicine, including managing medical operations and personnel, is strongly preferred. Experience in the areas of medical credentialing, networks, case management, workers compensation, or the analysis of the effectiveness and efficiency of medical providers and procedures is advantageous but not mandatory. The candidate should have a strong background in several of these areas.
Language Ability: Able to read, analyze, and interpret common scientific and technical journals, statutes, regulations, medical reports, medical coding, medical bills, financial reports, and legal documents. Able to respond to technical inquiries or complaints from Company employees, external sources, and regulatory or auditing entities. Able to effectively present information and respond to questions with managers, clients, claimants, attorneys, medical providers, and others. Able to write clear, effective correspondence on complex medical issues to people from all walks of life.
Math Ability: Able to calculate figures and amounts such as discounts, interest, proportions, percentages, sums, differences, products, and volumes.
Reasoning Ability: Able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Able to deal with problems involving several concrete variables in standardized situations.
Technical Skills: Knowledge of current recognized evidence based medicine guidelines, office operations, workflow analysis, and current technologies in telecommunications, data entry, and file management.
Computer Skills: Knowledge of Microsoft Office software. Able to quickly master proprietary and vended software applications.

COMPREHENSIVE BENEFITS PACKAGE:
Health
Dental
Vision
Life
Disability and AD&D
Retirement & Savings Plan with 100% employer match up to 5% of salary
Education Assistance Reimbursement
Paid Vacation and Holidays

ABOUT US:
The Berkshire Hathaway Homestate Companies (BHHC) is a group of six insurance companies that are part of the Berkshire Hathaway Insurance Group, headquartered in Omaha, Nebraska. Our Workers Compensation Division provides premier workers compensation insurance coverage to employers across the country, with offices in San Francisco, San Diego, Pasadena, Omaha, St. Louis, Atlanta, and Dallas.

As a member of the Berkshire Hathaway insurance group, BHHC has earned an enviable record of success in the insurance industry that is supported by an A++ A.M. Best rating, the highest rating they award insurance carriers. Our corporate size enables our organization to react swiftly and effectively to opportunities in the insurance marketplace. At the same time, our financial strength provides our agents and insureds the security rarely available in a regional specialty carrier.

We value each individual and recognize that attracting and retaining high quality talent is essential to the success of our company. Our structure minimizes bureaucracy and creates an environment that encourages our employees to see the direct effects of their hard work throughout the company. Each division provides hands on training and maintains a small company feel, creating an atmosphere in which 'team players' thrive.

BHHC - 12 months ago - save job - block
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