Managed Care Specialist

2 weeks ago


Gainesville, Florida, United States SCI Summit Consulting, LLC Full time

Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. As the people who know workers' comp, we strive to provide an atmosphere of constant growth and development for our employees.

Summit provides workers' compensation programs and services to thousands of employers throughout the Southeast.

Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it's underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise.

It's one thing to know workers' comp. It's another to know people. But knowing both? That creates an altogether different experience.

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

Monitors and facilitates each claimant's medical treatment to ensure appropriate, effective, cost-efficient, and quality care. Coordinates with vendors of rehabilitative services to ensure that services are consistent with the diagnosis and the goal of returning the claimant to employability and/or normal activities. Coordinates attendant care supervision, including the selection of appropriate care facilities. Assigns cases to vendors for utilization review. Provides professional advice and expertise to Claims staff in developing and providing medical and cost control procedures. Provides technical advice to lower level associates and other functional areas. Leads the work of others (mentors, prioritizes, delegates and reviews assignments). 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. The person hired for this position will work out of the Gainesville, GA office which offers a hybrid work environment of 3 days in the office and 2 days work from home.

#LI-Hybrid

Job Requirements

Education: Bachelor's Degree or equivalent; R.N. (Registered Nurse) or L.P.N. (Licensed Practical Nurse) preferred.

Field of Study: Business, Biology, Nursing or a related discipline.

Experience: Generally, 6 to 10 years of related experience, including Case Management experience.

This job is non-exempt in California

Company:

SCI Summit Consulting, LLC

Benefits:

We offer competitive healthcare, retirement, and paid time off benefits for full-time and part-time benefit eligible employees.



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