Director, Managed Care Services and Vendor Management

Responsibilities

• Design and execute medical management strategies to support early intervention and timely return-to-work outcomes
• Manage and develop the Managed Care Services team and foster collaboration with Claims Adjusters
• Oversee external medical management vendors including pharmacy, utilization review, case management, and IME providers
• Develop vendor strategy, including selection, onboarding, and enforcement of SLAs and KPIs
• Conduct regular vendor scorecards, audits, and business reviews to drive efficiency
• Partner with Claims leadership to align medical interventions with the claim lifecycle
• Drive initiatives to reduce medical spend and avoid opioid overutilization
• Implement standardized workflows and identify opportunities for automation and technology enablement
• Manage departmental budget and evaluate ROI of medical management programs
• Ensure compliance with state-specific W...