Sedgwick VP Medical Networks - Workers Compensation in Topeka, Kansas
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Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.
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VP Medical Networks - Workers Compensation
PRIMARY PURPOSE : To consult, advise, and develop best-in-class cost containment and bill review operations; responsible for networks development, oversight, and coordination, including development of optimal and outcomes-based network solutions for clients; act as liaison for network-related issues.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Provides input and insight into company's strategic PPO direction and long-term goal of moving industry toward best in class networks.
Provides MCO product management to meet state network jurisdictional needs including MCO, HCN, PPP, and MPN.
Acts as liaison to key network and provider partners ensuring strong network outcomes.
Responsible for strategic product enhancements and achieving industry best savings, penetration, and innovative solutions.
Responsible for strategic management of the provider benchmarking and search technology partnerships.
Provides leadership of network support teams including networks product managers.
Facilitates and leads optimal team structures for efficient and effective networks management including provider contracting and credentialing.
Serves as subject matter expert related to networks and related bill review services.
Provides legislative oversight for medical services program.
Participates as member of bill review planning, product services coordination, and operations team; ensures medical bill review processes meet client and colleague expectations; ensures that consistent product is delivered across multiple operations sites.
Facilitates client and organization education and outcomes reporting communication.
Oversees and coordinates vendor audits.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
Education & Licensing
Bachelor's degree from an accredited college or university preferred. MBA or successful senior level managed care experience within the medical bill review and network management areas strongly preferred.
Ten (10) years of related experience or equivalent combination of education and experience required to include five (5) years of management experience, workers compensation, claims and/or medical bill processing experience, and managed care cost containment experience including medical provider networks, bill review services, and customized client programs.
Skills & Knowledge
Strong knowledge of medical billing and/or claims management processes and procedures
Knowledge of state level workers' compensation rules and regulations for networks
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Strong analytical and interpretive skills
Strong organizational and financial skills
Excellent interpersonal skills
Excellent negotiation skills
Strategic management and project management skills
Ability to work in a team environment and individually
Ability to meet or exceed Performance Competencies
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical : Computer keyboarding, travel as required
Auditory/Visual : Hearing, vision and talking
NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
- As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in (Colorado or New York City). Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the state noted in this job posting only, the range of starting pay for this role is $115,825 - $162,463. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
Taking care of people is at the heart of everything we do. Caring counts
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)